Bone disease in primary hyperparathyroidism is a clear indication for surgical treatment.
However, it is not known whether surgery benefits hypercalcemic primary hyperparathyroidism
and normocalcemic primary hyperparathyroidism equally. The aim of our study was to
evaluate the bone changes in patients undergoing parathyroidectomy based on the biochemical
profile 1 and 2 years after surgery.
This prospective study included 87 consecutive patients diagnosed with primary hyperparathyroidism
who underwent surgery between 2016 and 2018. Bone densitometry (1/3 distal radius,
lumbar, and femur) and bone remodeling markers (osteocalcin, type 1 procollagen [P1NP],
β-cross-linked telopeptide of type I collagen [BCTX]) were performed preoperatively
and postoperatively. Postoperative changes in bone mineral density and bone markers
were compared and evaluated according to the clinical characteristics and the individual
One year after surgery, all patients showed an increase in bone mineral density at
the lumbar site (mean, 0.029 g/cm2; range, 0.017–0.04; P < .001) and femur neck (mean, 0.025 g/cm2; range, 0.002–0.05; P < .001); however, there were no changes in the distal third of the radius (mean,
-0.003 g/cm2; range, -0.008 to 0.002; P = NS). There were no significant differences when comparing normocalcemic primary
hyperparathyroidism and hypercalcemic primary hyperparathyroidism. Serum osteocalcin
(37 ± 17.41), P1NP (67.53 ± 31.81) and BCTX (0.64 ± 0.37) levels were elevated before
surgery. One year after the surgery, we observed a significant decrease in P1NP (33.05
± 13.16, P = .001), osteocalcin (15.80 ± 6.19, P = .001), and BCTX (0.26 ± 0.32, P < .001) levels.
Our findings indicate that parathyroidectomy has similar benefits for normocalcemic
primary hyperparathyroidism and hypercalcemic primary hyperparathyroidism in terms
of bone improvement. Although the most substantial improvement occurred during the
first postoperative year in both groups, we consider that studies with longer follow-up