Predictors of Nephrolithiasis, Osteoporosis, and Mortality in Primary Hyperparathyroidism

J Clin Endocrinol Metab. 2019 Sep 1;104(9):3692-3700. doi: 10.1210/jc.2018-02483.


Context: Primary hyperparathyroidism (PHPT) has a prevalence of 0.86% and is associated with increased risk of nephrolithiasis and osteoporosis. PHPT may also be associated with increased risk of cardiovascular disease and mortality.

Objective: To identify risk factors for nephrolithiasis, osteoporosis, and mortality in PHPT.

Design: Retrospective cohort study.

Setting: University teaching hospital.

Patients: Presented with PHPT between 2006 and 2014 (n = 611).

Main outcome measure: Assessment of nephrolithiasis, osteoporosis, and mortality.

Results: Of patients with PHPT, 13.9% had nephrolithiasis. Most had previously documented stone disease, and only 4.7% of asymptomatic patients who were screened for renal stones had calculi identified, not very dissimilar to the rate in the non-PHPT population. Younger age (P < 0.001) and male sex (P = 0.003) were the only independent predictors of nephrolithiasis. Of patients with dual-energy X-ray absorptiometry data, 48.4% had osteoporosis (223/461). Older age (P < 0.001), lower body mass index (P = 0.002), and lower creatinine (P = 0.006) were independently associated with a diagnosis of osteoporosis. Higher PTH was independently associated with lower z score at the hip (P = 0.009); otherwise, calcium and PTH were not associated with lower z scores. Mortality in PHPT was associated with older age (P < 0.008), social deprivation (P = 0.028), and adjusted calcium (P = 0.009) but not independently with PTH at diagnosis.

Conclusions: Screening for nephrolithiasis has a low yield, particularly in lower risk patients. Osteoporosis is only minimally associated with biochemical indices of PHPT. Mortality is associated with higher calcium (and possibly vitamin D deficiency) but not PTH.

MeSH terms

  • Aged
  • Biomarkers / analysis
  • Bone Density
  • Female
  • Follow-Up Studies
  • Humans
  • Hyperparathyroidism, Primary / complications
  • Hyperparathyroidism, Primary / mortality*
  • Male
  • Middle Aged
  • Mortality / trends*
  • Nephrolithiasis / diagnosis*
  • Nephrolithiasis / etiology
  • Nephrolithiasis / mortality
  • Osteoporosis / diagnosis*
  • Osteoporosis / etiology
  • Osteoporosis / mortality
  • Prognosis
  • Retrospective Studies
  • Risk Factors
  • Survival Rate


  • Biomarkers