{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T17:08:14Z","timestamp":1790874494888,"version":"4.1.0"},"reference-count":29,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2023,1,20]],"date-time":"2023-01-20T00:00:00Z","timestamp":1674172800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005689","name":"G\u00f6teborg Medical Society","doi-asserted-by":"publisher","award":["GLS\u2010596301"],"award-info":[{"award-number":["GLS\u2010596301"]}],"id":[{"id":"10.13039\/501100005689","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["asbmr.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Bone &amp; Mineral Res"],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Mild or asymptomatic disease is now the dominating presentation of primary hyperparathyroidism (PHPT). However, bone involvement with decreased bone mineral density (BMD) and an increased risk of fractures has been demonstrated. Indications for parathyroidectomy (PTX) in mild PHPT have been debated for years. There is a need of long\u2010term randomized studies comparing PTX with observation without intervention (OBS). Here, we present bone health data from the Scandinavian Investigation of Primary Hyperparathyroidism (SIPH), a randomized controlled trial, comparing PTX to OBS. This study included 191 patients (96 OBS\/95 PTX), and 129 patients (64 OBS\/65 PTX) were followed for 10\u2009years to the end of study (EOS). BMD was measured with dual\u2010energy X\u2010ray absorptiometry (DXA), peripheral fractures were noted, and spine radiographs were obtained for vertebral fracture assessment. There was a significant treatment effect of PTX on BMD compared with OBS for all analyzed compartments, most explicit for the lumbar spine (LS) and femoral neck (FN) (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). The mean changes in\n                    <jats:italic>T<\/jats:italic>\n                    \u2010score from baseline to 10\u2009years were from 0.41 for radius 33% (Rad33) to 0.58 for LS greater in the PTX group than in the OBS group. There was a significant decrease in BMD for all compartments in the OBS group, most pronounced for FN, Rad33, and ultradistal radius (UDR) (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). Even though there was a significant treatment effect of PTX compared with OBS, there was only a significant increase in BMD over time for LS (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.001). We found no difference between groups in fracture frequency in the 10\u2010year cohort, neither with modified intention\u2010to\u2010treat (mITT) analysis nor per protocol analysis. Because BMD is only a surrogate endpoint of bone health and PTX did not reduce fracture risk, observation could be considered a safe option for many patients with mild PHPT regarding bone health in a 10\u2010year perspective. \u00a9 2023 The Authors.\n                    <jats:italic>Journal of Bone and Mineral Research<\/jats:italic>\n                    published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).\n                  <\/jats:p>","DOI":"10.1002\/jbmr.4763","type":"journal-article","created":{"date-parts":[[2023,1,3]],"date-time":"2023-01-03T00:19:56Z","timestamp":1672705196000},"page":"372-380","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Positive Effect of Parathyroidectomy Compared to Observation on\n                    <scp>BMD<\/scp>\n                    in a Randomized Controlled Trial of Mild Primary Hyperparathyroidism"],"prefix":"10.1093","volume":"38","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1560-5195","authenticated-orcid":false,"given":"Karolina","family":"Lundstam","sequence":"first","affiliation":[{"name":"Department of Radiology, Institute of Clinical Sciences The Sahlgrenska Academy, University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Radiology Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9017-5116","authenticated-orcid":false,"given":"Mikkel","family":"Pretorius","sequence":"additional","affiliation":[{"name":"Section of Specialized Endocrinology Oslo University Hospital  Oslo Norway"},{"name":"Faculty of Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0654-4610","authenticated-orcid":false,"given":"Jens","family":"Bollerslev","sequence":"additional","affiliation":[{"name":"Section of Specialized Endocrinology Oslo University Hospital  Oslo Norway"},{"name":"Faculty of Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3407-3657","authenticated-orcid":false,"given":"Kristin","family":"Godang","sequence":"additional","affiliation":[{"name":"Section of Specialized Endocrinology Oslo University Hospital  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morten W","family":"Fagerland","sequence":"additional","affiliation":[{"name":"Oslo Centre for Biostatistics and Epidemiology, Research Support Services Oslo University Hospital  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Mollerup","sequence":"additional","affiliation":[{"name":"Clinic of Breast and Endocrine Surgery, Center HOC Copenhagen University Hospital, Rigshospitalet  Copenhagen Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stine L","family":"Fougner","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital Trondheim University Hospital  Trondheim Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ylva","family":"Pernow","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery, Department of Endocrinology Karolinska Institutet, Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Turid","family":"Aas","sequence":"additional","affiliation":[{"name":"Department of Breast and Endocrine Surgery Haukeland University Hospital  Bergen Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ola","family":"Hessman","sequence":"additional","affiliation":[{"name":"Department of Surgery and Centre for Clinical Research of Uppsala University V\u00e4stmanland's Hospital  V\u00e4ster\u00e5s Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thord","family":"Ros\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Medicine, Section of Endocrinology, Diabetes, and Metabolism Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00f6rgen","family":"Nordenstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine and Surgery Karolinska Institutet, Karolinska University Hospital  Stockholm Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svante","family":"Jansson","sequence":"additional","affiliation":[{"name":"Department of Surgery, Institute of Clinical Sciences Sahlgrenska Academy at the University of Gothenburg, Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikael","family":"Hellstr\u00f6m","sequence":"additional","affiliation":[{"name":"Department of Radiology, Institute of Clinical Sciences The Sahlgrenska Academy, University of Gothenburg  Gothenburg Sweden"},{"name":"Department of Radiology Sahlgrenska University Hospital  Gothenburg Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3443-884X","authenticated-orcid":false,"given":"Ansgar","family":"Heck","sequence":"additional","affiliation":[{"name":"Section of Specialized Endocrinology Oslo University Hospital  Oslo Norway"},{"name":"Faculty of Medicine University of Oslo  Oslo Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,1,20]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2016.2310"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-1415"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-114-7-593"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-021370"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-1763"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-1413"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2007.03162.x"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2796.2005.01600.x"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2017-01932"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00423-012-1026-5"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S8756-3282(99)00150-7"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2007-1215"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2004-0028"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2007-0219"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.3177"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2014-3441"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.7326\/M21-4416"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2006-1836"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jocd.2021.07.002"},{"key":"e_1_2_9_21_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199910213411701"},{"key":"e_1_2_9_22_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-004-7274-y"},{"issue":"1277","key":"e_1_2_9_23_1","first-page":"18","article-title":"Prospective 10\u2010year study of postmenopausal women with asymptomatic primary hyperparathyroidism","volume":"121","author":"Bolland MJ","year":"2008","journal-title":"N Z Med J."},{"key":"e_1_2_9_24_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2017-01080"},{"key":"e_1_2_9_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.maturitas.2020.11.007"},{"key":"e_1_2_9_26_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-13-0305"},{"key":"e_1_2_9_27_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2008-2006"},{"key":"e_1_2_9_28_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2021.6437"},{"key":"e_1_2_9_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2017.01.024"},{"key":"e_1_2_9_30_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0244291"}],"container-title":["Journal of Bone and Mineral 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