Bone-modifying agents may alter biochemical presentation and operative findings in primary hyperparathyroidism
In brief
Bone-drug users had more multigland disease: 43% versus 32%
Among 899 patients who had surgery for primary hyperparathyroidism, those with a history of bone-modifying drug use had lower average calcium and parathyroid hormone levels, but multigland disease was more common (43% versus 32%). This single-center retrospective study shows an association, not that the drugs caused these differences; whether their use should change preoperative evaluation remains unclear.
- Journal
- Surgery (Q1)
- Published
- 1 September 2026
- Study design
- Cohort / observational study
- Evidence level
- Level 3, Low (CEBM 3b)
- Authors
- Abigail C Chmiel, Genesys Giraldo, Caroline Jones, Meredith Freeman, Naga M Yalla, William E Gillanders, et al.
- PMID
- 42791099
- DOI
- 10.1016/j.surg.2026.110587
Why clinicians should know about it
- Picked for Breast and Endocrine Surgery (paper of the day, 28 September 2026): Neck hematoma, hypocalcemia after thyroidectomy
Abstract
BACKGROUND: Primary hyperparathyroidism is closely linked to bone metabolism, leading to increased bone resorption and osteoporosis. Bone-modifying agents are commonly used to mitigate bone loss by altering calcium metabolism; however, their effect on the biochemical and operative presentation of primary hyperparathyroidism has not been well characterized. This study evaluates the association between bone-modifying agent use, biochemical markers, and operative findings among patients with primary hyperparathyroidism. METHODS: A retrospective review was conducted of patients who underwent parathyroidectomy for primary hyperparathyroidism between 2019 and 2025 at a single tertiary referral center. A history of bone-modifying agent use and bone disease was assessed. Descriptive statistics and univariate analyses were performed to evaluate associations between bone-modifying agent use and the biochemical and operative phenotypes of primary hyperparathyroidism. RESULTS: A total of 899 patients met inclusion criteria, of whom 187 (20.8%) had a history of bone-modifying agent use. Patients with bone-modifying agent use were more likely to be female (P < .001), White (P < .001), and older on average (70 vs 60 years, P < .001). Mean serum calcium levels (10.5 vs 10.9 mg/dL, P < .001) and mean parathyroid hormone levels (99.5 vs 119.7 pg/mL, P < .001) were lower among bone-modifying agent users. Multigland disease was more frequent in bone-modifying agent users (43% vs 32%, P = .03) as was bilateral neck exploration (54% vs 45%, P = .033). CONCLUSION: In patients undergoing parathyroidectomy for primary hyperparathyroidism, the use of bone-modifying agents is associated with a distinct biochemical profile and a higher prevalence of multigland disease. A more nuanced understanding of the relationship between bone-modifying agents and the pathophysiology and surgical presentation of primary hyperparathyroidism could inform preoperative planning and guide individualized evaluation strategies in this patient population.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.