Bisphosphonate Therapy and the Occurrence of the Hungry Bone Syndrome After Surgery for Primary Hyperparathyroidism

Hungry bone syndrome (HBS), marked by severe and persistent hypocalcemia, frequently occurs after parathyroidectomy for primary hyperparathyroidism (PHPT). Despite its prevalence, there is limited research on this complication. This study aimed to assess the impact of preoperative bisphosphonate treatment on the incidence of postoperative HBS in PHPT patients.

This retrospective study analyzed hospital records of patients with PHPT who underwent parathyroidectomy from January 2010 to January 2020.

The study included 144 patients with PHPT who underwent curative parathyroidectomy at AL-Zahra University Hospital within the specified timeframe. Patients with secondary or tertiary hyperparathyroidism or unsuccessful surgeries were excluded.

Data on bisphosphonate use, clinical, and laboratory parameters were reviewed. Logistic regression analyzed the relationship between preoperative bisphosphonate treatment and the occurrence of postoperative HBS.

Of the total of 144 patients, 19 received preoperative bisphosphonate therapy. The incidence of HBS was significantly higher in the bisphosphonate group (57.9%) compared to the nontreated group (11.2%) (p < 0.001). However, logistic regression analysis revealed no significant reduction in HBS occurrence due to bisphosphonate treatment, either in the overall cohort or in patients with moderate to severe hypercalcemia (calcium level ≥ 12 mg/dL) (odds ratio: 3.4, 95% CI: 0.5-22.7, p=0.191; odds ratio: 15.0, 95% CI: 0.6-383.9, p=0.102, respectively).

Preoperative bisphosphonate therapy does not prevent the development of HBS following parathyroidectomy for PHPT. Continuous postoperative calcium monitoring is essential for effective management and mitigation of HBS.