Hungry bone syndrome commonly occurs after parathyroidectomy with autotransplantation (PTx) in patients with secondary hyperparathyroidism on hemodialysis, and high preoperative serum alkaline phosphatase (ALP) and low serum calcium may be risk factors for the syndrome, according to new study findings published in International Urology and Nephrology.

To better understand post-PTx hungry bone syndrome (serum total calcium level less than 2.1 mmol/L or post-PTx hypocalcemia for more than 4 days), investigators from The First Affiliated Hospital of Nanjing Medical University in China examined changes in bone metabolism biomarkers during the perioperative period for 115 patients.

Guang Yang, MD, PhD, and colleagues found increased levels of markers of bone formation, resorption, and regulation before surgery, indicating high turnover disease. By 3 days after PTx, serum intact parathyroid hormone (iPTH), calcitonin, C-telopeptides, and tartrate-resistant acid phosphatase 5b had decreased significantly, whereas osteocalcin and ALP levels had increased significantly. PTx appeared to foster osteoblast activity and reduce osteoclast activity, easing high turnover, the investigators explained.

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Hungry bone syndrome developed in 101 patients (87.8%) after PTx. In multiple linear regression analysis, high preoperative serum ALP and low preoperative serum calcium independently correlated with the need for intravenous calcium. According to Dr Yang and the team, younger patients with higher preoperative serum ALP and iPTH may experience more severe hungry bone syndrome and should receive calcium supplementation after surgery and be monitored closely for hypocalcemia.

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Ge Y, Yang G, Wang N, et al. Bone metabolism markers and hungry bone syndrome after parathyroidectomy in dialysis patients with secondary hyperparathyroidism. Int Urol Nephrol. 2019. doi:10.1007/s11255-019-02217-y