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Hungry bone syndrome.

Nishank Jain1, Robert F Reilly

  • 1aDivision of Nephrology, University of Arkansas for Medical Sciences bCentral Arkansas Veterans Affairs Healthcare System, Little Rock, Arkansas cOffice of Education, Central Alabama Veterans Healthcare System, Montgomery, Alabama, USA.

Current Opinion in Nephrology and Hypertension
|April 5, 2017
PubMed
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Hungry bone syndrome (HBS) is a severe drop in calcium post-parathyroidectomy, often seen in dialysis patients with secondary hyperparathyroidism. Early intervention with calcium and calcitriol is key to managing this condition.

Area of Science:

  • Nephrology
  • Endocrinology
  • Bone Metabolism

Background:

  • Parathyroidectomy is performed in patients with hyperparathyroidism, particularly those on chronic dialysis.
  • A common complication is a drop in serum calcium, which can become severe and prolonged, termed hungry bone syndrome (HBS).
  • HBS is characterized by hypocalcemia and may involve hypophosphatemia, hypomagnesemia, and hyperkalemia.

Purpose of the Study:

  • To review the current understanding of hungry bone syndrome (HBS) in patients undergoing parathyroidectomy.
  • To identify risk factors and current management strategies for HBS.
  • To discuss the potential role of bisphosphonates in preventing HBS.

Main Methods:

  • Review of recent in-vitro studies on calcium movement post-parathyroid hormone (PTH) fall.

Related Experiment Videos

  • Analysis of clinical observations regarding HBS incidence in primary versus secondary hyperparathyroidism.
  • Discussion of preoperative and postoperative management strategies.

    • Main Results:

    • In-vitro studies suggest a sudden drop in PTH after surgery leads to calcium influx into bone.
    • HBS is more frequently observed in chronic dialysis patients with secondary hyperparathyroidism compared to primary hyperparathyroidism.
    • Preoperative indicators for HBS risk include bone radiological changes, elevated alkaline phosphatase and PTH, and high osteoclast numbers.

    Conclusions:

    • HBS is a significant concern post-parathyroidectomy, especially in secondary hyperparathyroidism patients on dialysis.
    • High-dose oral calcium and calcitriol are standard treatments for HBS.
    • Further research is needed to evaluate bisphosphonates for HBS prevention.