What happens to the bone structure after normocalcemic primary hyperparathyroidism surgery?

Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism is Associated with Improved Bone Mineral Density Regardless of Postoperative Parathyroid Hormone Levels

“…In an effort to reconcile these conflicting results, Sho et al [7] compared BMD changes in nPHPT who did and did not have postoperative PTH normalization and concluded that BMD improvement may be contingent on PTH normalization. Our data confirm results by Koumakis et al [9] and Osorio-Silla et al [11] as both hPHPT and nPHPT patients saw statistically significant improvement at multiple skeletal sites. When specifically looking at nPHPT patients and stratifying based on postoperative PTH levels, there was no clear pattern in which patients saw BMD improvement.…”

“…Since first reported that nPHPT patients saw BMD improvement 1 year after parathyroidectomy by Koumakis et al [9], follow‐up studies looking at BMD changes have had mixed findings. After a thorough work‐up for secondary causes, Osorio‐Silla et al [11] found that nPHPT patients had increased BMD 1 year after surgery, while Lee et al [10] saw no significant changes. In an effort to reconcile these conflicting results, Sho et al [7] compared BMD changes in nPHPT who did and did not have postoperative PTH normalization and concluded that BMD improvement may be contingent on PTH normalization.…”

“…However, as recent publications have become more rigorous in the diagnosis of nPHPT, some have highlighted that large proportions of nPHPT patients actually do not achieve biochemical cure after surgery, as defined as normalization of PTH levels by 6 months postoperatively [7,8]. Furthermore, while it has been shown that parathyroidectomy has long-term benefits in bone mineral density (BMD) in hPHPT patients, and it remains unclear whether these benefits are seen in nPHPT patients [7,[9][10][11].…”

Letter to the Editor: Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism (nPHPT) is Associated with Improved Bone Mineral Density Regardless of Postoperative Parathyroid Hormone Levels

“…We congratulate the authors on their study on bone mineral density (BMD) changes in Normocalcemic Hyperparathyroidism which is a new kid on the block, even in developing Countries now which are showing increasing trends. In this context Normocalcemic Hyperparathyroidism has been a difficult entity for the endocrine surgeons to understand in terms of the physiology involved, the reset of calcium switch pre‐ and post‐surgery, increased incidence of multi glandular disease, decreased PTH normalization after surgery, seasonal variation and also the reversal of end organ changes [2, 3].…”