Asymptomatic primary hyperparathyroidism: surgical and medical management

Primary hyperparathyroidism (PHPT) is a common endocrine disorder, frequently asymptomatic. Notwithstanding, mild PHPT may cause adverse skeletal effects that include high bone remodeling, reduced bone mineral density (BMD), and increased fracture risk. The definitive therapy for symptomatic and asymptomatic PHPT (aPHPT) is parathyroidectomy, which has been shown to increase BMD. In patients who choose not to be treated surgically or have contraindications for surgery, medical therapy should include drugs designed to protect the skeleton and/or to lower serum calcium, such as bisphosphonates, hormone replacement, and/or calcimimetic agents. However, there are currently no fracture data for any of these options. Obviously, there is the need for larger randomized controlled trials with fractures as end-points to evaluate the efficacy of medical treatment.