Hungry bone syndrome following parathyroidectomy for primary hyperparathyroidism in a developed country in the Asia Pacific. A cohort study

Manju Chandran; John P Bilezikian; Nurshazwani Mat Salleh; Hao Ying; Joel Lau; James Lee; Mechteld C deJong; Aye Chan Maung; Rajeev Parameswaran

doi:10.1016/j.afos.2022.03.004

Hungry bone syndrome following parathyroidectomy for primary hyperparathyroidism in a developed country in the Asia Pacific. A cohort study

Osteoporos Sarcopenia. 2022 Mar;8(1):11-16. doi: 10.1016/j.afos.2022.03.004. Epub 2022 Mar 24.

Authors

Manju Chandran¹, John P Bilezikian², Nurshazwani Mat Salleh³, Hao Ying⁴, Joel Lau⁵, James Lee⁵, Mechteld C deJong⁵, Aye Chan Maung^{3

6}, Rajeev Parameswaran⁵

Affiliations

¹ Osteoporosis and Complicated Metabolic Bone Disorders Unit, Department of Endocrinology, Singapore General Hospital, Singapore.
² Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA.
³ Department of Endocrinology, Singapore General Hospital, Singapore.
⁴ National Public Health and Epidemiology Unit, National Centre for Infectious Diseases, Singapore.
⁵ Department of Endocrine Surgery, National University Hospital, Singapore.
⁶ Department of Endocrinology, Ealing Hospital, London North West Healthcare NHS Trust, United Kingdom.

Abstract

Objectives: We sought to assess the incidence of hungry bone syndrome (HBS) following parathyroidectomy (PTX) for primary hyperparathyroidism (PHPT) in a cohort of multi-ethnic patients from a developed country in the Asia Pacific.

Methods: One hundred and sixty-four patients who underwent PTX for PHPT between 2012 and 2019 at the 2 largest public hospitals in Singapore were identified. HBS was defined as serum albumin-adjusted calcium ≤ 2.1 mmol/L with normal or raised serum intact parathyroid hormone (iPTH) levels, manifesting on or after the 3rd day, or persisting for more than 3 days post-operatively.

Results: Chinese constituted 73.8%, Malays 12.2%, Indians 9.8%, and other races 4.3%. HBS developed in 4 patients (2.4%) (95% CI, 0.8%-6.5%). HBS patients had significantly longer in-hospital stays; 20 days [IQR:15-22] vs 2 days [IQR:1-3]; P < 0.001in those who did not develop HBS. There was no difference in the incidence of HBS stratifying for age, sex, vitamin D status, or use of preoperative anti-resorptive medication use. For every 10 unit increase in iPTH and alkaline phosphatase (ALP) levels, the risk of HBS increased by 14% and 11%; RR (95% CI), 1.14 (1.05-1.21) and 1.11 (1.03-1.18), respectively.

Conclusions: The low incidence of HBS in multi-ethnic patients undergoing PTX by multiple surgeons for PHPT at the 2 largest public hospitals that see the most such patients in Singapore, a developed country, is consistent with the asymptomatic/milder form of presentation of PHPT in the developed world.

Keywords: Hungry bone syndrome; Parathyroidectomy; Primary hyperparathyroidism.