THURSDAY, March 26, 2026 (HealthDay News) -- The Fracture Risk Assessment Tool (FRAX) estimation exhibits acceptable performance among patients with primary hyperparathyroidism (PHPT), according to a study published online March 19 in JAMA Network Open.
Vivek R. Sant, M.D., from the UT Southwestern Medical Center in Dallas, and colleagues conducted a retrospective cohort study to examine the calibration of FRAX in adults with PHPT using the TriNetX electronic health record U.S. dataset and to describe the differential fracture risk with parathyroidectomy (PTX) versus nonsurgical management. Participants included adults aged 40 to 90 years with diagnosis or biochemistry findings consistent with PHPT.
Overall, 25.0 percent of the 59,194 patients with PHPT were treated with PTX. The researchers found that for all deciles of risk, observed major osteoporotic fracture (MOF) and hip fractures were slightly greater than estimated by FRAX, with an MOF and hip fracture calibration y-intercept of 2.0 and 1.4 percent, respectively, and slope of 1.17 and 1.02, respectively. PTX was associated with reductions in MOF and hip fracture (hazard ratios [95 percent confidence intervals], 0.88 [0.77 to 1.02] and 0.87 [0.72 to 1.07], respectively). The MOF score and corresponding hip score above which PTX was associated with consistently lower MOF hazard and consistently lower hip fracture hazard was 1.2 and 2.7 percent, respectively. Twenty-five percent of the cohort not meeting traditional guideline-based surgical criteria met this hip score for consistent fracture reduction associated with PTX.
"The study provides the first large-scale validation of FRAX in primary hyperparathyroidism and reframes fracture prevention as a quantifiable, risk-based outcome for surgical decision-making rather than relying solely on bone density thresholds," Sant said in a statement.