{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T09:26:47Z","timestamp":1792056407037,"version":"4.4.0"},"reference-count":55,"publisher":"The Endocrine Society","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2009,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Background: Primary hyperparathyroidism (PHPT) is a common endocrine disorder that is frequently asymptomatic. The 2002 International Workshop on Asymptomatic PHPT addressed medical management of asymptomatic PHPT and summarized the data on nonsurgical approaches to this disease. At the Third International Workshop on Asymptomatic PHPT held in May 2008, this subject was reviewed again in light of data that have since become available. We present the results of a literature review of advances in the medical management of PHPT.<\/jats:p>\n               <jats:p>Methods: A series of questions was developed by the International Task Force on PHPT. A comprehensive literature search for relevant studies evaluating the management of PHPT with bisphosphonates, hormone replacement therapy, raloxifene, and calcimimetics was conducted. Existing guidelines and recent unpublished data were also reviewed. All selected relevant articles were reviewed, and the questions developed by the International Task Force were addressed by the Consensus Panel.<\/jats:p>\n               <jats:p>Results: Bisphosphonates and hormone replacement therapy are effective in decreasing bone turnover in patients with PHPT and improving bone mineral density (BMD). Fracture data are not available with either treatment. Raloxifene also lowers bone turnover in patients with PHPT. None of these agents, however, significantly lowers serum calcium or PTH levels. The calcimimetic cinacalcet reduces both serum calcium and PTH levels and raises serum phosphorus. Cinacalcet does not, however, reduce bone turnover or improve BMD.<\/jats:p>\n               <jats:p>Conclusions: Bisphosphonates and hormone replacement therapy provide skeletal protection in patients with PHPT. Limited data are available regarding skeletal protection in patients with PHPT treated with raloxifene. Calcimimetics favorably alter serum calcium and PTH in PHPT but do not significantly affect either bone turnover or BMD. Medical management of asymptomatic PHPT is a promising option for those who are not candidates for parathyroidectomy.<\/jats:p>","DOI":"10.1210\/jc.2008-1762","type":"journal-article","created":{"date-parts":[[2009,2,4]],"date-time":"2009-02-04T18:43:07Z","timestamp":1233772987000},"page":"373-381","source":"Crossref","is-referenced-by-count":97,"title":["Medical Management of Asymptomatic Primary Hyperparathyroidism: Proceedings of the Third International Workshop"],"prefix":"10.1210","volume":"94","author":[{"given":"Aliya","family":"Khan","sequence":"first","affiliation":[{"name":"McMaster University (A.K.), Hamilton, Ontario, Canada L8S 4L8"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Grey","sequence":"first","affiliation":[{"name":"University of Auckland (A.G.), Auckland 1142, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dolores","family":"Shoback","sequence":"first","affiliation":[{"name":"University of California, San Francisco (D.S.), San Francisco, California 94143"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"80","reference":[{"key":"2020071613102984500_R1","doi-asserted-by":"crossref","first-page":"5353","DOI":"10.1210\/jc.2002-021370","article-title":"Summary statement from a workshop on asymptomatic primary hyperparathyroidism: a perspective for the 21st century.","volume":"87","author":"Bilezikian","year":"2002","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613102984500_R2","doi-asserted-by":"crossref","first-page":"3462","DOI":"10.1210\/jc.2007-1215","article-title":"The natural history of primary hyperparathyroidism with or without parathyroid surgery after 15 years.","volume":"93","author":"Rubin","year":"2008","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613102984500_R3","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1530\/eje.1.02029","article-title":"Surgery versus medical follow-up in patients with asymptomatic primary hyperparathyroidism: a decision analysis.","volume":"153","author":"Sejean","year":"2005","journal-title":"Eur J Endocrinol"},{"key":"2020071613102984500_R4","doi-asserted-by":"crossref","first-page":"874","DOI":"10.1016\/j.surg.2006.07.032","article-title":"Cost effectiveness analysis of parathyroidectomy for asymptomatic primary hyperparathyroidism.","volume":"140","author":"Zanocco","year":"2006","journal-title":"Surgery"},{"key":"2020071613102984500_R5","doi-asserted-by":"crossref","first-page":"290","DOI":"10.1016\/j.surg.2008.03.044","article-title":"How should age at diagnosis impact treatment strategy in asymptomatic primary hyperparathyroidism? A cost-effectiveness analysis.","volume":"144","author":"Zanocco","year":"2008","journal-title":"Surgery"},{"key":"2020071613102984500_R6","doi-asserted-by":"crossref","first-page":"5415","DOI":"10.1210\/jc.2004-0028","article-title":"Randomized controlled clinical trial of surgery versus no surgery in patients with mild asymptomatic primary hyperparathyroidism.","volume":"89","author":"Rao","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613102984500_R7","doi-asserted-by":"crossref","first-page":"1687","DOI":"10.1210\/jc.2006-1836","article-title":"Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial.","volume":"92","author":"Bollerslev","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613102984500_R8","doi-asserted-by":"crossref","first-page":"3114","DOI":"10.1210\/jc.2007-0219","article-title":"Surgery or surveillance of mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial.","volume":"92","author":"Ambrogini","year":"2007","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613102984500_R9","first-page":"S353","article-title":"Long term morbidity and mortality in untreated mild primary hyperparathyroidism","volume":"22","author":"Iskander","year":"2007","journal-title":"J Bone Miner Res"},{"key":"2020071613102984500_R10","first-page":"18","article-title":"Prospective 10-year study of postmenopausal women with asymptomatic primary hyperparathyroidism.","volume":"121","author":"Bolland","year":"2008","journal-title":"N Z Med J"},{"key":"2020071613102984500_R11","doi-asserted-by":"crossref","first-page":"1249","DOI":"10.1056\/NEJM199910213411701","article-title":"A 10-year prospective study of primary hyperparathyroidism with or without parathyroid surgery.","volume":"341","author":"Silverberg","year":"1999","journal-title":"N Engl J Med"},{"key":"2020071613102984500_R12","doi-asserted-by":"crossref","first-page":"1700","DOI":"10.1359\/jbmr.1997.12.10.1700","article-title":"Elimination and biochemical responses to intravenous alendronate in postmenopausal osteoporosis.","volume":"12","author":"Khan","year":"1997","journal-title":"J Bone Miner Res"},{"key":"2020071613102984500_R13","first-page":"14","article-title":"The effects of alendronate on bone turnover and bone quality.","volume":"101","author":"Meunier","year":"1999","journal-title":"Int J Clin Pract Suppl"},{"key":"2020071613102984500_R14","doi-asserted-by":"crossref","first-page":"2010","DOI":"10.1016\/S0140-6736(06)68891-0","article-title":"Osteoporosis.","volume":"367","author":"Sambrook","year":"2006","journal-title":"Lancet"},{"key":"2020071613102984500_R15","doi-asserted-by":"crossref","first-page":"23","DOI":"10.7326\/0003-4819-95-1-23","article-title":"Effects of dichloromethylene diphosphonate on serum and urinary calcium in primary hyperparathyroidism.","volume":"95","author":"Shane","year":"1981","journal-title":"Ann Intern Med"},{"issue":"Suppl 1","key":"2020071613102984500_R16","first-page":"S69","article-title":"Clodronate in the medical management of hyperparathyroidism","volume":"8","author":"Hamdy","year":"1987","journal-title":"Bone"},{"key":"2020071613102984500_R17","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1111\/j.1365-2265.1990.tb00504.x","article-title":"Regulation of calcium parathyroid hormone feedback in primary hyperparathyroidism. Effects of bisphosphonate treatment.","volume":"33","author":"Adami","year":"1990","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2020071613102984500_R18","doi-asserted-by":"crossref","first-page":"2063","DOI":"10.1001\/jama.1983.03330390067035","article-title":"Treatment of hyperparathyroidism with etidronate disodium.","volume":"249","author":"Licata","year":"1983","journal-title":"JAMA"},{"key":"2020071613102984500_R19","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/j.1365-2265.1990.tb00869.x","article-title":"Aminopropylidine diphosphonate (ADP) in mild primary hyperparathyroidism: effects on clinical status.","volume":"32","author":"Schmidli","year":"1990","journal-title":"Clin Endocrinol (Oxf)"},{"key":"2020071613102984500_R20","first-page":"1067","article-title":"Acute changes in calcium homeostasis during treatment of primary hyperparathyroidism with risedronate.","volume":"77","author":"Reasner","year":"1993","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613102984500_R21","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1359\/jbmr.2001.16.1.113","article-title":"Effects of oral alendronate in elderly patients with osteoporosis and mild primary hyperparathyroidism.","volume":"16","author":"Rossini","year":"2001","journal-title":"J Bone Miner Res"},{"key":"2020071613102984500_R22","doi-asserted-by":"crossref","first-page":"581","DOI":"10.1210\/jc.2002-020890","article-title":"Oral alendronate increases bone mineral density in postmenopausal women with primary hyperparathyroidism.","volume":"88","author":"Chow","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613102984500_R23","doi-asserted-by":"crossref","first-page":"3319","DOI":"10.1210\/jc.2003-030908","article-title":"Alendronate in primary hyperparathyroidism: a double blind, randomized, placebo controlled trial.","volume":"89","author":"Khan","year":"2004","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613102984500_R24","doi-asserted-by":"crossref","first-page":"4482","DOI":"10.1210\/jc.2001-010385","article-title":"Alendronate in the treatment of primary hyperparathyroid-related osteoporosis: a 2-year study.","volume":"87","author":"Parker","year":"2002","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613102984500_R25","doi-asserted-by":"crossref","first-page":"633","DOI":"10.7326\/0003-4819-100-5-633","article-title":"Conjugated estrogens in the treatment of postmenopausal women with hyperparathyroidism.","volume":"100","author":"Marcus","year":"1984","journal-title":"Ann Intern Med"},{"key":"2020071613102984500_R26","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.1056\/NEJM198606053142304","article-title":"Ethinyl estradiol and norethindrone in the treatment of primary hyperparathyroidism in postmenopausal women.","volume":"314","author":"Selby","year":"1986","journal-title":"N Engl J Med"},{"key":"2020071613102984500_R27","doi-asserted-by":"crossref","first-page":"360","DOI":"10.7326\/0003-4819-125-5-199609010-00002","article-title":"Effect of hormone replacement therapy on bone mineral density in postmenopausal women with mild primary hyperparathyroidism. A randomized, controlled trial.","volume":"125","author":"Grey","year":"1996","journal-title":"Ann Intern Med"},{"key":"2020071613102984500_R28","first-page":"1997","article-title":"Hormone replacement therapy causes a respiratory alkalosis in normal postmenopausal women.","volume":"84","author":"Orr-Walker","year":"1999","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613102984500_R29","first-page":"179","article-title":"The redistribution of body sodium in women on long-term oestrogen therapy.","volume":"47","author":"Aitken","year":"1974","journal-title":"Clin Sci Mol Med"},{"key":"2020071613102984500_R30","doi-asserted-by":"crossref","first-page":"1151","DOI":"10.1016\/S0140-6736(80)92592-1","article-title":"Prevention of spinal osteoporosis in oophorectomised women.","volume":"2","author":"Lindsay","year":"1980","journal-title":"Lancet"},{"key":"2020071613102984500_R31","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1001\/jama.288.3.321","article-title":"Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results from the Women\u2019s Health Initiative randomized controlled trial.","volume":"288","author":"Rossouw","year":"2002","journal-title":"JAMA"},{"key":"2020071613102984500_R32","doi-asserted-by":"crossref","first-page":"2161","DOI":"10.1001\/archinte.160.14.2161","article-title":"Effects of hormone replacement therapy on bone mineral density in postmenopausal women with primary hyperparathyroidism: four-year follow-up and comparison with healthy postmenopausal women.","volume":"160","author":"Orr-Walker","year":"2000","journal-title":"Arch Intern Med"},{"key":"2020071613102984500_R33","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1007\/BF01623394","article-title":"Estrogen replacement may be an alternative to parathyroid surgery for the treatment of osteoporosis in elderly postmenopausal women presenting with primary hyperparathyroidism: a preliminary report.","volume":"6","author":"Diamond","year":"1996","journal-title":"Osteoporos Int"},{"key":"2020071613102984500_R34","first-page":"3487","article-title":"Longitudinal changes in bone mineral density and bone turnover in postmenopausal women with primary hyperparathyroidism.","volume":"81","author":"Guo","year":"1996","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613102984500_R35","doi-asserted-by":"crossref","first-page":"618","DOI":"10.1056\/NEJMra022219","article-title":"Selective estrogen-receptor modulators\u2014mechanisms of action and application to clinical practice.","volume":"348","author":"Riggs","year":"2003","journal-title":"N Engl J Med"},{"key":"2020071613102984500_R36","doi-asserted-by":"crossref","first-page":"871","DOI":"10.1001\/archinte.164.8.871","article-title":"A comparison of the effects of raloxifene and conjugated equine estrogen on bone and lipids in healthy postmenopausal women.","volume":"164","author":"Reid","year":"2004","journal-title":"Arch Intern Med"},{"key":"2020071613102984500_R37","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1056\/NEJMoa062462","article-title":"Effects of raloxifene on cardiovascular events and breast cancer in postmenopausal women.","volume":"355","author":"Barrett-Connor","year":"2006","journal-title":"N Engl J Med"},{"key":"2020071613102984500_R38","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1001\/jama.282.7.637","article-title":"Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators.","volume":"282","author":"Ettinger","year":"1999","journal-title":"JAMA"},{"key":"2020071613102984500_R39","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1210\/jc.2002-020667","article-title":"Raloxifene lowers serum calcium and markers of bone turnover in postmenopausal women with primary hyperparathyroidism.","volume":"88","author":"Rubin","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613102984500_R40","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1359\/jbmr.2001.16.1.189","article-title":"Raloxifene reverses bone loss in postmenopausal women with mild asymptomatic primary hyperparathyroidism.","volume":"16","author":"Zanchetta","year":"2001","journal-title":"J Bone Miner Res"},{"key":"2020071613102984500_R41","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1038\/366575a0","article-title":"Cloning and characterization of an extracellular Ca(2+)-sensing receptor from bovine parathyroid.","volume":"366","author":"Brown","year":"1993","journal-title":"Nature"},{"key":"2020071613102984500_R42","doi-asserted-by":"crossref","first-page":"4040","DOI":"10.1073\/pnas.95.7.4040","article-title":"Calcimimetics with potent and selective activity on the parathyroid calcium receptor.","volume":"95","author":"Nemeth","year":"1998","journal-title":"Proc Natl Acad Sci USA"},{"issue":"Suppl 2","key":"2020071613102984500_R43","first-page":"N141","article-title":"Calcimimetics in the treatment of primary hyperparathyroidism","volume":"17","author":"Antoniucci","year":"2002","journal-title":"J Bone Miner Res"},{"key":"2020071613102984500_R44","doi-asserted-by":"crossref","first-page":"530","DOI":"10.1038\/nrm1154","article-title":"Extracellular calcium sensing and signaling.","volume":"4","author":"Hofer","year":"2003","journal-title":"Nat Rev Mol Cell Biol"},{"key":"2020071613102984500_R45","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.ceca.2003.10.020","article-title":"Calcimimetic and calcilytic drugs: just for parathyroid cells?","volume":"35","author":"Nemeth","year":"2004","journal-title":"Cell Calcium"},{"key":"2020071613102984500_R46","doi-asserted-by":"crossref","first-page":"2237","DOI":"10.1016\/S0140-6736(05)66782-7","article-title":"Calcimimetic and calcilytics\u2014fooling the calcium receptor.","volume":"365","author":"Steddon","year":"2005","journal-title":"Lancet"},{"key":"2020071613102984500_R47","doi-asserted-by":"crossref","first-page":"627","DOI":"10.1124\/jpet.103.057273","article-title":"Pharmacodynamics of the type II calcimimetic compound cinacalcet HCl.","volume":"308","author":"Nemeth","year":"2004","journal-title":"J Pharmacol Exp Ther"},{"key":"2020071613102984500_R48","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1111\/j.1523-1755.2005.67103.x","article-title":"Cinacalcet HCl attenuates parathyroid hyperplasia in a rat model of secondary hyperparathyroidism.","volume":"67","author":"Colloton","year":"2005","journal-title":"Kidney Int"},{"key":"2020071613102984500_R49","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1172\/JCI10523","article-title":"Primary hyperparathyroidism caused by parathyroid-targeted overexpression of cyclin D1 in transgenic mice.","volume":"107","author":"Imanishi","year":"2001","journal-title":"J Clin Invest"},{"key":"2020071613102984500_R50","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1530\/eje.1.02007","article-title":"Relationship between parathyroid calcium-sensing receptor expression and potency of the calcimimetic, cinacalcet, in suppressing parathyroid hormone secretion in an in vivo murine model of primary hyperparathyroidism.","volume":"153","author":"Kawata","year":"2005","journal-title":"Eur J Endocrinol"},{"key":"2020071613102984500_R51","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1056\/NEJM199711203372104","article-title":"Short-term inhibition of parathyroid hormone secretion by a calcium-receptor agonist in patients with primary hyperparathyroidism.","volume":"337","author":"Silverberg","year":"1997","journal-title":"N Engl J Med"},{"key":"2020071613102984500_R52","doi-asserted-by":"crossref","first-page":"1083","DOI":"10.1210\/jcem.83.4.4726","article-title":"Treatment of hypercalcemia secondary to parathyroid carcinoma with a novel calcimimetic agent.","volume":"83","author":"Collins","year":"1998","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613102984500_R53","doi-asserted-by":"crossref","first-page":"5644","DOI":"10.1210\/jc.2002-021597","article-title":"The calcimimetic AMG 073 normalizes serum calcium in patients with primary hyperparathyroidism.","volume":"88","author":"Shoback","year":"2003","journal-title":"J Clin Endocrinol Metab"},{"key":"2020071613102984500_R54","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1210\/jc.2004-0842","article-title":"Cinacalcet hydrochloride maintains long-term normocalcemia in patients with primary hyperparathyroidism.","volume":"90","author":"Peacock","year":"2005","journal-title":"J Clin Endocrinol Metab"},{"issue":"Suppl 1","key":"2020071613102984500_R55","first-page":"S38","article-title":"Long-term control of primary hyperparathyroidism with cinacalcet HCl","volume":"21","author":"Peacock","year":"2006","journal-title":"J Bone Miner Res"}],"container-title":["The Journal of Clinical Endocrinology &amp; Metabolism"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/jcem\/article-pdf\/94\/2\/373\/9057368\/jcem0373.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/jcem\/article-pdf\/94\/2\/373\/9057368\/jcem0373.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,7,16]],"date-time":"2020-07-16T23:14:51Z","timestamp":1594941291000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jcem\/article\/94\/2\/373\/2597855"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,2,1]]},"references-count":55,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2009,2,1]]}},"URL":"https:\/\/doi.org\/10.1210\/jc.2008-1762","relation":{},"ISSN":["0021-972X","1945-7197"],"issn-type":[{"value":"0021-972X","type":"print"},{"value":"1945-7197","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,2,1]]}}}