Parathyroid bone disease in the medical management of primary hyperparathyroidism

Crowley Mairead T; Deirdre Green; Oghenekevwe Uyovbisere; Eniola Amosu; Ruth Cullen; Maria Byrne; Mensud Hatunic; Brendan Kinsley; Recie Davern; Siobhan McQuaid; O; Nigel Glynn

doi:10.1530/endoabs.117.P72

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Endocrine Abstracts (2026) 117 P72 | DOI: 10.1530/endoabs.117.P72

SFEBES2026 Poster Presentations Bone and Calcium (28 abstracts)

Parathyroid bone disease in the medical management of primary hyperparathyroidism

Mairead T Crowley , Deirdre Green , Oghenekevwe Uyovbisere , Eniola Amosu , Ruth Cullen , Maria Byrne , Mensud Hatunic , Brendan Kinsley , Recie Davern , Siobhán McQuaid , Paula M. O’Shea & Nigel Glynn

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Mater Misericordiae University Hospital, Dublin, Ireland

Background: The natural history of bone disease in primary hyperparathyroidism (PHPT) is uncertain when managed without parathyroidectomy. 25-hydroxyvitamin D deficiency can further raise parathyroid hormone and potentially worsen bone disease. This study aimed to assess the prevalence of reduced bone mineral density (BMD) in a cohort with medically managed PHPT and to establish efficacy and tolerability of vitamin D supplementation, BMD-targeted therapy and cinacalcet.

Methods: A retrospective review of 90 individuals with PHPT attending a single centre. Parameters included biochemistry, radiology and prescription history. Data are described in mean +/- SD and percentages and frequencies (Graphpad v10.4.2).

Results: The mean age was 66.3 ± 11.7 years, adjusted calcium 2.77 ± 0.1mmol/l, PTH 10.7 ± 4.4mmol/l and vitamin D 64 ± 36nmol/l. 83 (92%) had a DEXA scan. Osteoporosis and osteopenia were identified in 30 (36%) and 37 (45%) respectively. Single site reduced forearm BMD was identified in seven cases (14%). There was no difference in age, gender, adjusted calcium, PTH and vitamin D in those with reduced and preserved BMD (all P > 0.05). 36 individuals (40%) commenced vitamin D at daily dose of 855 ± 237units with no significant change in adjusted calcium (2.68 ± 0.06 vs 2.69 ± 0.06 mmol/l, P = 0.39), serum phosphate (0.85 ± 0.13 vs 0.88 ± 0.16 mmol/l, P = 0.26) or PTH (11.7 ± 4.5 vs 11.0 ± 4.3 pmol/l, P = 0.17). BMD-targeted therapy and cinacalcet were prescribed to 32 (36%) and 23 patients (26%) respectively. 23 patients (26%) commenced cinacalcet.

Conclusion: Parathyroid bone disease is common in medically managed PHPT. Biochemical parameters are a poor predictor of the severity of bone disease. These findings suggest that maintenance dose vitamin D in PHPT does not significantly alter adjusted calcium, phosphate or PTH over the observed treatment period.