Vitamin D Pretreatment to Prevent the Risk of Postoperative Hypocalcemic Complications After Parathyroidectomy in Primary Hyperparathyroidism: A Systematic Review and Meta-Analysis.

Abstract

Parathyroidectomy is the treatment for primary hyperparathyroidism, yet postoperative hypocalcemia and hungry bone syndrome remain common. Vitamin D deficiency has been suggested as a modifiable risk factor, but evidence supporting preoperative supplementation is inconsistent. Following PRISMA guidelines, we systematically searched five databases (up to January 2025) for studies evaluating vitamin D supplementation before parathyroidectomy in primary hyperparathyroidism. Data were extracted in duplicate, risk of bias assessed, and random-effects meta-analyses performed. Nine studies (three RCTs and six cohorts; n = 2750) were included. Vitamin D supplementation significantly reduced postoperative hypocalcemia (RR: 0.35, 95% CI: 0.18-0.66), symptomatic hypocalcemia (RR: 0.53, 95% CI: 0.29-1.00), and length of stay (MD: -0.51 days, 95% CI: -0.55 to -0.46). Trends favored supplementation for decreasing the risk of hungry bone syndrome and requiring calcium supplementation. Preoperative vitamin D appears safe and may reduce hypocalcemia-related complications after parathyroidectomy, though current evidence is of low quality.