Lower Limb Fractures in Primary Hyperparathyroidism: A Systematic Review and Meta-Analysis of Incidence, Biochemical Risk Factors, and Surgical Management.

OBJECTIVE

Although skeletal fragility in primary hyperparathyroidism (pHPT) is well-recognized, data specific to lower limb fractures, the most disabling fractures, remain fragmented. This study aims to systematically synthesize evidence based on the existing literature to describe lower limb fractures in patients with pHPT, with emphasis on fracture characteristics and surgical management, and to perform a meta-analysis quantifying the risk of lower limb fracture in these patients.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we conducted a comprehensive search across PubMed, Embase, Scopus, and Web of Science to identify studies reporting lower limb fractures in patients with pHPT. The risk of bias of the included studies was evaluated using the Joanna Briggs Institute Critical Appraisal Checklist. Meta-analyses were conducted to assess the prevalence of lower limb fractures in each anatomical site, the mean difference of serum biochemicals in patients with and without fracture, and to evaluate the protective effect of parathyroidectomy.

RESULTS

A total of 140 studies were included in the systematic review, of which 16 observational studies contributed to quantitative analyses. The pooled prevalence of lower-limb fractures among included observational cohorts was 12%. The pooled hazard ratio from studies assessing the effect of parathyroidectomy on fracture risk was 0.78, indicating a reduction in fracture risk after parathyroidectomy. Evaluation of serum parathyroid hormone, calcium, and 25-hydroxy vitamin D levels showed no significant difference in patients with and without fractures.

CONCLUSION

Femoral and tibial involvement predominates, reflecting severe cortical compromise. Parathyroidectomy substantially reduces fracture risk. Orthopedic surgeons should consider metabolic screening in atypical or low-energy long bone fractures.