{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T12:22:14Z","timestamp":1782476534346,"version":"3.54.5"},"reference-count":33,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T00:00:00Z","timestamp":1780099200000},"content-version":"vor","delay-in-days":149,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Case Reports in Endocrinology"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>The optimal timing of denosumab therapy in relation to parathyroid surgery to avoid hypocalcemia and rebound bone resorption is not well described. Herein we report the case of a 62\u2010year\u2010old woman with steroid\u2010induced osteoporosis who received denosumab for several years prior to undergoing parathyroidectomy. She had a history of lupus and required 20\u201360\u2009mg of daily prednisone. Prior to her presentation at our institution, she was initially treated with alendronate and calcium\/vitamin D supplementation. A dual\u2010energy X\u2010ray absorptiometry (DXA) scan 4 years after starting prednisone showed stable osteopenia in the lumbar spine and total hip but osteoporosis in the femoral neck with a significant reduction of bone mineral density (BMD) by 15.4% since baseline. Denosumab was initiated by her local endocrinologist for antiresorptive therapy due to declining bone density while on alendronate. She remained on prednisone for three additional years while on denosumab. 3 years of denosumab therapy resulted in stable bone density. Vitamin D levels were appropriate but elevations in PTH and calcium were noted. What was initially thought to be secondary hyperparathyroidism was at this point consistent with primary hyperparathyroidism (PHPT). A 4\u2010dimensional computed tomography (4D CT) scan of the neck identified a parathyroid adenoma, and she was referred to our institution for parathyroidectomy. The timing of parathyroidectomy in relationship to the next denosumab injection was a concern due to the rebound bone resorption phenomenon and increased risk of vertebral fractures if denosumab is delayed or missed. Conversely, if denosumab is given in the periprocedural period, severe postsurgical hypocalcemia can result if denosumab prevents liberation of calcium from bone. Considering this, parathyroidectomy was performed 6 months after the last denosumab dose, and it was resumed 8 weeks after surgery. 1 month after surgery, calcium was normal, and PTH had recovered to mid\u2010normal range. Her postoperative course was uncomplicated, and she was able to resume denosumab.<\/jats:p>","DOI":"10.1155\/crie\/8562872","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:46:41Z","timestamp":1780134401000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Timing of Denosumab Therapy in Relation to Parathyroidectomy in the Setting of Primary Hyperparathyroidism: Case Report"],"prefix":"10.1155","volume":"2026","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7797-2754","authenticated-orcid":false,"given":"Ryan S.","family":"MacLeod","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4975-5645","authenticated-orcid":false,"given":"Adriana","family":"Ramirez","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4056-3409","authenticated-orcid":false,"given":"Barbara","family":"Gulanski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0997-3098","authenticated-orcid":false,"given":"Sachin K.","family":"Majumdar","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,30]]},"reference":[{"key":"e_1_2_9_1_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2018-01225"},{"key":"e_1_2_9_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/nrendo.2017.104"},{"key":"e_1_2_9_3_2","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.4677"},{"key":"e_1_2_9_4_2","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.2001.16.1.113"},{"key":"e_1_2_9_5_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2001-010385"},{"key":"e_1_2_9_6_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2002-020890"},{"key":"e_1_2_9_7_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2003-030908"},{"key":"e_1_2_9_8_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(20)30063-2"},{"key":"e_1_2_9_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.15250"},{"key":"e_1_2_9_10_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMcp1800214"},{"key":"e_1_2_9_11_2","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001347.pub2"},{"key":"e_1_2_9_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(18)30075-5"},{"key":"e_1_2_9_13_2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaa756"},{"key":"e_1_2_9_14_2","doi-asserted-by":"crossref","DOI":"10.21037\/aot-20-64","article-title":"Parathyroidectomy in a Patient Treated with Denosumab: A Case Report","volume":"6","author":"Tanavde V.","year":"2021","journal-title":"Annals of Thyroid"},{"key":"e_1_2_9_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.eprac.2022.09.006"},{"key":"e_1_2_9_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.bonr.2021.101148"},{"key":"e_1_2_9_17_2","doi-asserted-by":"publisher","DOI":"10.20945\/2359-3997000000408"},{"key":"e_1_2_9_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/cen.12188"},{"key":"e_1_2_9_19_2","doi-asserted-by":"publisher","DOI":"10.1038\/boneres.2017.21"},{"key":"e_1_2_9_20_2","doi-asserted-by":"publisher","DOI":"10.1159\/000499824"},{"key":"e_1_2_9_21_2","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.4685"},{"key":"e_1_2_9_22_2","doi-asserted-by":"publisher","DOI":"10.1210\/clinem\/dgaf107"},{"key":"e_1_2_9_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s12020-020-02401-6"},{"key":"e_1_2_9_24_2","doi-asserted-by":"publisher","DOI":"10.1210\/jc.2010-1502"},{"key":"e_1_2_9_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-8587(17)30138-9"},{"key":"e_1_2_9_26_2","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/j.bone.2008.04.007","article-title":"Effect of Denosumab on Bone Density and Turnover in Postmenopausal Women With Low Bone Mass After Long-Term Continued, Discontinued, and Restarting of Therapy: A Randomized Blinded Phase 2 Clinical Trial1","volume":"43","author":"Miller P. 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