Dallas, Mar 20: A widely used fracture risk calculator, the Fracture Risk Assessment Tool (FRAX), could help guide surgical decisions for patients with primary hyperparathyroidism (PHPT), an endocrine disorder that causes progressive bone loss, according to a new study led by researchers at UT Southwestern Medical Center. The findings, published in JAMA Network Open, suggest FRAX may identify patients who would benefit from a parathyroidectomy to prevent fractures.
“This 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,” said lead author Vivek Sant, M.D., Assistant Professor of Surgery at UT Southwestern.
PHPT affects nearly 3 million Americans and results from overactive parathyroid glands producing excess hormones, elevating calcium levels and weakening bones. While parathyroidectomy – surgical removal of one or more parathyroid glands – is the only curative treatment, identifying which patients should undergo surgery has been challenging.
For the study, UT Southwestern researchers analyzed a national database of 59,194 adults aged 40–90 diagnosed with PHPT between 2000 and 2024. Approximately 25% underwent parathyroidectomy, while the remainder received nonsurgical management. Using FRAX scores to predict fracture risk, the team found the tool effectively identified patients likely to benefit from surgery, even when bone mineral density data were unavailable.
The study also revealed that many patients who do not meet traditional surgical criteria may still exceed risk thresholds for fractures. Among these patients, 25% had FRAX hip fracture scores above the level associated with reduced fracture risk after surgery.
“These findings provide clinicians with a practical, widely available tool to personalize surgical discussions, enabling more informed shared decision-making,” said senior author Naim Maalouf, M.D., Professor of Internal Medicine and Associate Director of the Charles and Jane Pak Center for Mineral Metabolism and Clinical Research at UT Southwestern.
Other contributing researchers include Yaser ElNakieb, Ph.D.; Justin Rousseau, M.D., M.M.Sc.; Yu-Lun Liu, Ph.D.; and Craig Rubin, M.D. The study was supported by the American Association of Endocrine Surgeons Foundation Paul LoGerfo Research Award and the National Center for Advancing Translational Sciences of the National Institutes of Health.
