Several clinical factors might contribute to hungry bone syndrome after parathyroidectomy (PTx) in patients with secondary hyperparathyroidism (SHPT) of renal origin, according to investigators.

Of 796 patients who underwent PTx, 164 patients (20.6%) experienced hungry bone syndrome. Affected patients were significantly younger than unaffected patients: mean age 45.7 vs 50.7 years, Rachel R. Kelz, MD, MSCE, MBA, of the Hospital of the University of Pennsylvania in Philadelphia, and colleagues reported in Surgery. Hungry bone syndrome also was significantly more common among obese than nonobese patients: 25.0% vs 15.8%. In a multivariate analysis, the odds of hungry bone syndrome significantly increased 1.5-fold with obesity and 5.2-fold with weight loss. According to the investigators, weight loss may be a surrogate for renal osteodystrophy, malnutrition, and/or hypoalbuminemia.

With respect to comorbidities, patients with fluid and electrolyte disorders and cardiac arrhythmias had significant 1.5- and 2.1-fold increased odds for hungry bone syndrome, respectively. Patients with metastatic cancer also had significantly increased risks possibly due to the presence of bony metastases. Osteoporosis did not increase risks for the syndrome.

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PTx with autotransplantation was performed at similar rates in the groups that did and did not experience hungry bone syndrome (23.8% vs 23.1%), the investigators reported. The overall complication rate (9.1% vs 16.6%) and hypocalcemia rate (7.9% vs 16.0%) were significantly lower among patients in whom the syndrome developed.

Median length of hospital stay was a significant 3 days longer for the group with hungry bone syndrome: 6 vs 3 days. Affected and unaffected patients had similar 30-day readmission rates (25% vs 23%).

According to Dr Kelz’s team, clinicians should counsel patients with SHPT of renal origin considering PTx that they may have a relatively long hospital stay for intravenous calcium supplementation if hungry bone syndrome occurs.

“Preoperative discussions regarding the anticipated length of stay have been shown to be associated with a reduction in length of stay and enhanced patient satisfaction likely due to the setting of realistic expectations,” they wrote.


Williams-Karnesky RL, Krumeich L, Wachtel H, et al. Data to inform counseling on parathyroidectomy for secondary hyperparathyroidism of renal origin. Surgery. Published online September 5, 2020. doi:10.1016/j.surg.2021.08.009