Change in Bone Mineral Density After Parathyroidectomy for Secondary Hyperparathyroidism: A Review.

Abstract

Secondary hyperparathyroidism is a common complication of chronic kidney disease that accelerates bone loss and increases fracture risk. While parathyroidectomy (PTx) is the definitive treatment for medically refractory cases, its impact on bone mineral density (BMD) has not been comprehensively evaluated. A systematic search of PubMed, Embase, and Scopus was conducted from inception through January 2026. Studies were included if they reported dual-energy X-ray absorptiometry-measured BMD before and after PTx in adults with secondary hyperparathyroidism due to chronic kidney disease. Two reviewers independently screened and selected studies using the PICOS framework, and additional articles were identified through reference searching. Across 11 studies encompassing 452 patients with paired measurements, all demonstrated significant improvement in BMD following a site-specific hierarchy favoring cancellous bone. The lumbar spine (+7-50% g/cm2) and femoral neck (+8-23% g/cm2) showed the most consistent gains, while the distal radius showed minimal change. Higher preoperative parathyroid hormone levels, elevated alkaline phosphatase, and lower baseline BMD were associated with greater skeletal recovery. The only available randomized trial confirmed the superiority of PTx over cinacalcet for bone density improvement. PTx consistently improves BMD in patients with refractory secondary hyperparathyroidism, with the greatest gains at cancellous-rich skeletal sites. Clinicians should consider the skeletal benefits of PTx when counseling patients with medically refractory disease, particularly those with low baseline bone density and markedly elevated parathyroid hormone levels.