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<p>Hungry bone syndrome (HBS) is a well-recognised complication after curative parathyroidectomy in primary hyperparathyroidism (PHPT), contributing to morbidity and prolonged hospitalisation. Reported predictors remain inconsistent, and data from Indian cohorts are limited, particularly in settings where vitamin D deficiency and advanced skeletal disease may modify risk. This retrospective observational cohort study was conducted at a tertiary surgical centre between January 2023 and December 2025. Twenty-five consecutive patients with biochemically proven PHPT who underwent curative parathyroidectomy were included. Preoperative variables included serum calcium, phosphate, parathyroid hormone (PTH), alkaline phosphatase (ALP), and 25-OH vitamin D. For this study, HBS was defined as postoperative hypocalcaemia persisting for more than 72&#xa0;h after surgery and requiring clinically significant calcium supplementation; transient asymptomatic biochemical hypocalcaemia was not classified as HBS. Receiver operating characteristic (ROC) curves were constructed, and a three-point bedside score was evaluated in an exploratory manner. HBS developed in 7 patients (28%). Preoperative PTH showed the strongest discriminatory performance for HBS, with 83% sensitivity and 70% specificity at a cut-off of 300 pg/mL (AUROC 0.79). ALP ≥ 200 IU/L showed comparable performance, with 71% sensitivity and 72% specificity (AUROC 0.76). Vitamin D deficiency (&lt; 20 ng/mL) showed a directionally increased risk but was not independently significant on multivariable analysis. Serum calcium was not predictive. The three-point bedside score, based on PTH, ALP, and vitamin D, showed a graded increase in HBS risk across score categories, and no patient with a score of 0 developed HBS. In this exploratory cohort, HBS occurred in nearly one-third of Indian PHPT patients. Combined preoperative biochemical assessment using routinely available markers may improve perioperative risk stratification. The proposed bedside score provides a simple, hypothesis-generating framework, but validation in larger prospective multicentric studies is required before clinical implementation.</p>

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Biochemical Predictors of Hungry Bone Syndrome in Primary Hyperparathyroidism: Evidence from an Indian Cohort

  • 期刊论文

  • 发表日期：

    2026年5月12日

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  • Surjeet Dwivedi,
  • Sabita Dwivedi,
  • Amit Gaur,
  • Sanjay Kumar,
  • Manoj Kumar,
  • Chandan Sinha,
  • Mandeep Sharma,
  • Anghusman Dutta,
  • Paramvir Singh Kahlon,
  • Shreyansh Chaudhary

摘要

Hungry bone syndrome (HBS) is a well-recognised complication after curative parathyroidectomy in primary hyperparathyroidism (PHPT), contributing to morbidity and prolonged hospitalisation. Reported predictors remain inconsistent, and data from Indian cohorts are limited, particularly in settings where vitamin D deficiency and advanced skeletal disease may modify risk. This retrospective observational cohort study was conducted at a tertiary surgical centre between January 2023 and December 2025. Twenty-five consecutive patients with biochemically proven PHPT who underwent curative parathyroidectomy were included. Preoperative variables included serum calcium, phosphate, parathyroid hormone (PTH), alkaline phosphatase (ALP), and 25-OH vitamin D. For this study, HBS was defined as postoperative hypocalcaemia persisting for more than 72 h after surgery and requiring clinically significant calcium supplementation; transient asymptomatic biochemical hypocalcaemia was not classified as HBS. Receiver operating characteristic (ROC) curves were constructed, and a three-point bedside score was evaluated in an exploratory manner. HBS developed in 7 patients (28%). Preoperative PTH showed the strongest discriminatory performance for HBS, with 83% sensitivity and 70% specificity at a cut-off of 300 pg/mL (AUROC 0.79). ALP ≥ 200 IU/L showed comparable performance, with 71% sensitivity and 72% specificity (AUROC 0.76). Vitamin D deficiency (< 20 ng/mL) showed a directionally increased risk but was not independently significant on multivariable analysis. Serum calcium was not predictive. The three-point bedside score, based on PTH, ALP, and vitamin D, showed a graded increase in HBS risk across score categories, and no patient with a score of 0 developed HBS. In this exploratory cohort, HBS occurred in nearly one-third of Indian PHPT patients. Combined preoperative biochemical assessment using routinely available markers may improve perioperative risk stratification. The proposed bedside score provides a simple, hypothesis-generating framework, but validation in larger prospective multicentric studies is required before clinical implementation.