ReviewJournal of clinical medicine2025
Hungry Bone Syndrome After Parathyroidectomy for Secondary Hyperparathyroidism: Pathogenesis and Contemporary Clinical Considerations.
Review in Journal of clinical medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed.
- Commentary on "Predictive value of preoperative bone turnover markers for early postoperative severe hypocalcemia in patients with maintenance hemodialysis and secondary hyperparathyroidism".International urology and nephrology · 2026Article
- A Clinically Aligned Two-Stage Machine Learning Framework for Predicting Hungry Bone Syndrome After Parathyroidectomy.Endocrinology, diabetes & metabolism · 2026Article
- Predictive value of preoperative bone turnover markers for early postoperative severe hypocalcemia in patients with maintenance hemodialysis and secondary hyperparathyroidism.International urology and nephrology · 2026Article
- Hungry bone syndrome-like state following denosumab in a patient with multiple myeloma.JCEM case reports · 2026Article
- Pre-Parathyroidectomy PTH as an Integrated Biomarker of Glandular Remodeling and Skeletal Turnover in Secondary Hyperparathyroidism.International journal of molecular sciences · 2026Review
- Article
- Predicting Hungry Bone Syndrome with Interpretable Machine Learning: A Single-Center Cohort of Dialysis Patients Undergoing Parathyroidectomy.Diagnostics (Basel, Switzerland) · 2026Article
- Independent Predictors of Hungry Bone Syndrome After Parathyroidectomy for Primary Hyperparathyroidism: Insights from a Large Cohort Study.Diagnostics (Basel, Switzerland) · 2026Article
- Clinical and Biochemical Correlates of Parathyroid Gland Burden in Patients Undergoing Parathyroidectomy for Secondary Hyperparathyroidism: A Retrospective Observational Study.Journal of clinical medicine · 2026Article
- Giant Parathyroid Adenoma Masked by Severe Vitamin D Deficiency with Hypocalcemic Presentation: A Case Report.International medical case reports journal · 2026Article
- Periodontal disease and endocrine imbalance: a molecular pathways perspective.Frontiers in dental medicine · 2026Review
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Secondary hyperparathyroidism (SHPT) in chronic kidney disease often necessitates parathyroidectomy (PTX), but this definitive treatment can precipitate hungry bone syndrome (HBS)-a profound, prolonged hypocalcemia caused by the rapid skeletal uptake of minerals after surgery. HBS results from the abrupt cessation of parathyroid hormone (PTH)-driven bone resorption while bone formation continues, leading to intensive mineral deposition (mainly calcium) into chronically demineralized bone. Clinically, HBS ranges from asymptomatic biochemical disturbances to life-threatening hypocalcemia with tetany, seizures, and/or cardiac arrhythmias. This illustrative review synthesizes current knowledge of HBS pathogenesis and management in the context of SHPT. We detail how the high-turnover bone remodeling state of SHPT (osteitis fibrosa cystica) creates an expansive unmineralized osteoid pool that avidly mineralizes post-PTX. We also explore molecular mechanisms (e.g., RANKL/OPG dysregulation, Wnt/β-catenin activation, osteocyte-driven signals, and calcium-sensing receptor effects) that underpin this process. Key preoperative risk factors for HBS include very elevated PTH and alkaline phosphatase levels, large skeletal calcium deficits, younger patient age, and total PTX. We outline the typical postoperative course of HBS, phased from immediate acute hypocalcemia to a nadir and gradual recovery. Prevention and management strategies are emphasized, centered on vigilant monitoring and aggressive calcium and calcitriol supplementation, with preoperative optimization (e.g., vitamin D loading, calcimimetics) to mitigate severity. By enhancing risk stratification and perioperative care, clinicians can improve outcomes and safely navigate patients through this challenging complication of endocrine surgery.
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