{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:53:57Z","timestamp":1787727237742,"version":"build-2784847793"},"reference-count":30,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T00:00:00Z","timestamp":1774828800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Hungry bone syndrome (HBS) is a clinically significant metabolic complication following parathyroidectomy for primary hyperparathyroidism (PHPT), characterized by profound and prolonged hypocalcemia resulting from rapid skeletal remineralization. Although multiple risk factors have been proposed, published data remain inconsistent regarding the most reliable predictors. This study aimed to evaluate potential risk factors associated with the development of HBS and to clarify controversial findings reported in the literature. Methods: Patients who underwent surgery for PHPT between January 2019 and May 2025 were retrospectively analyzed. Individuals who developed HBS were compared with those who did not in terms of clinical, biochemical, and surgical parameters. Results: HBS occurred in 4.7% of patients. Those in the HBS group exhibited significantly higher preoperative serum calcium, parathyroid hormone, alkaline phosphatase (ALP), and Ca\/P ratio, while phosphate, vitamin D, and T-scores were significantly lower. Postoperative day 1 calcium levels were also markedly reduced. Multivariate analysis identified increased ALP, low T-score, concomitant thyroid surgery, and decreased postoperative day 1 calcium as independent predictors. A postoperative day 1 calcium cutoff of 8.6 mg\/dL demonstrated strong predictive accuracy. Conclusions: HBS is more commonly observed in patients with low bone density and high bone turnover. Patients with these risk factors should be considered high-risk and closely monitored in the early postoperative period to enable prompt intervention and prevent severe complications.<\/jats:p>","DOI":"10.3390\/diagnostics16071041","type":"journal-article","created":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T12:11:59Z","timestamp":1774872719000},"page":"1041","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Independent Predictors of Hungry Bone Syndrome After Parathyroidectomy for Primary Hyperparathyroidism: Insights from a Large Cohort Study"],"prefix":"10.3390","volume":"16","author":[{"given":"Ibrahim","family":"Kilinc","sequence":"first","affiliation":[{"name":"Department of General Surgery, Ankara Bilkent City Hospital, Universiteler Mahallesi, Bilkent, Cankaya, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustafa","family":"Oruc","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ankara Bilkent City Hospital, Universiteler Mahallesi, Bilkent, Cankaya, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Furkan","family":"Savas","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ankara Bilkent City Hospital, Universiteler Mahallesi, Bilkent, Cankaya, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alparslan","family":"Ertenlice","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ankara Bilkent City Hospital, Universiteler Mahallesi, Bilkent, Cankaya, 06800 Ankara, T\u00fcrkiye"},{"name":"Department of General Surgery, Faculty of Medicine, Ankara Y\u0131ld\u0131r\u0131m Beyaz\u0131t University, Universiteler Mahallesi, Ihsan Dogramaci Caddesi, Cankaya, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9014-7070","authenticated-orcid":false,"given":"Serap","family":"Ulusoy","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Ankara Bilkent City Hospital, Universiteler Mahallesi, Bilkent, Cankaya, 06800 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,30]]},"reference":[{"key":"ref_1","first-page":"45","article-title":"Risk factors of developing the hungry bone syndrome after parathyroidectomy for primary hyperparathyroidism","volume":"25","author":"Jakubauskas","year":"2018","journal-title":"Acta Med. Litu."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Carsote, M., and Nistor, C. (2023). Forestalling hungry bone syndrome after parathyroidectomy in patients with primary and renal hyperparathyroidism. Diagnostics, 13.","DOI":"10.3390\/diagnostics13111953"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"134","DOI":"10.1111\/hdi.13067","article-title":"Hungry bone syndrome after parathyroid surgery","volume":"27","author":"Tai","year":"2023","journal-title":"Hemodial. Int."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Coman, A., Tarta, C., Marian, M., Popa, D.I., Olariu, S., Rosu, M., Utu, D., Buleu, F., Macovei-Oprescu, A.M., and Novacescu, D. (2025). Hungry bone syndrome after parathyroidectomy for secondary hyperparathyroidism: Pathogenesis and contemporary clinical considerations. J. Clin. Med., 14.","DOI":"10.3390\/jcm14197104"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1016\/0002-9343(88)90100-3","article-title":"Hungry bone syndrome: Clinical and biochemical predictors of its occurrence after parathyroid surgery","volume":"84","author":"Brasier","year":"1988","journal-title":"Am. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Coman, A., Tarta, C., Aiordachioae, G.A., Goldis, D., Utu, D., Marian, M., Dobrescu, A., Buleu, F., and Olariu, S. (2025). Predictors of hungry bone syndrome and reintervention after subtotal versus total parathyroidectomy for secondary hyperparathyroidism in dialysis patients: A single-center cohort. J. Clin. Med., 14.","DOI":"10.3390\/jcm14144944"},{"key":"ref_7","first-page":"11","article-title":"Hungry bone syndrome in patients operated for primary hyperparathyroidism: A six-year experience","volume":"32","author":"Cudal","year":"2017","journal-title":"Philipp. J. Otolaryngol. Head Neck Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1530\/EJE-17-0416","article-title":"The impact of vitamin D status on hungry bone syndrome after surgery for primary hyperparathyroidism","volume":"178","author":"Kaderli","year":"2018","journal-title":"Eur. J. Endocrinol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"R45","DOI":"10.1530\/EJE-12-0528","article-title":"Hungry bone syndrome: Still a challenge in the postoperative management of primary hyperparathyroidism\u2014A systematic review of the literature","volume":"168","author":"Witteveen","year":"2013","journal-title":"Eur. J. Endocrinol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1016\/j.coph.2015.03.005","article-title":"Parathyroid hormone: Anabolic and catabolic actions on the skeleton","volume":"22","author":"Silva","year":"2015","journal-title":"Curr. Opin. Pharmacol."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Ho, L.-Y., Wong, P.-N., Sin, H.-K., Wong, Y.-Y., Lo, K.-C., Chan, S.-F., Lo, M.-W., Lo, K.-Y., Mak, S.-K., and Wong, A.K.-M. (2017). Risk factors and clinical course of hungry bone syndrome after total parathyroidectomy in dialysis patients with secondary hyperparathyroidism. BMC Nephrol., 18.","DOI":"10.1186\/s12882-016-0421-5"},{"key":"ref_12","first-page":"168","article-title":"Hungry bone syndrome after parathyroidectomy for primary hyperparathyroidism","volume":"4","author":"Ghilardi","year":"2014","journal-title":"Surg. Curr. Res."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"3751","DOI":"10.1007\/s00268-020-05711-y","article-title":"Risk factors for prolonged length of stay and readmission after parathyroidectomy for renal secondary hyperparathyroidism","volume":"44","author":"Stefanova","year":"2020","journal-title":"World J. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"952","DOI":"10.2215\/CJN.10390917","article-title":"Parathyroidectomy in the management of secondary hyperparathyroidism","volume":"13","author":"Lau","year":"2018","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1097\/MNH.0000000000000327","article-title":"Hungry bone syndrome","volume":"26","author":"Jain","year":"2017","journal-title":"Curr. Opin. Nephrol. Hypertens."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"79","DOI":"10.4103\/0022-3859.65279","article-title":"Clinical profile of primary hyperparathyroidism from western India: A single center experience","volume":"56","author":"Gopal","year":"2010","journal-title":"J. Postgrad. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"29","DOI":"10.5144\/0256-4947.2005.29","article-title":"Primary hyperparathyroidism in north India: A description of 52 cases","volume":"25","author":"Bhansali","year":"2005","journal-title":"Ann. Saudi Med."},{"key":"ref_18","first-page":"310","article-title":"Risk factors and evolution of calcium and parathyroid hormone levels in hungry bone syndrome after parathyroidectomy for primary hyperparathyroidism","volume":"67","year":"2020","journal-title":"Endocrinol. Diabetes Nutr. (Engl. Ed.)"},{"key":"ref_19","first-page":"552","article-title":"Risk factors for severe postoperative hypocalcaemia after operations for primary hyperparathyroidism","volume":"168","author":"Kald","year":"2002","journal-title":"Eur. J. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"131","DOI":"10.2147\/IJNRD.S47179","article-title":"Incidence of and risk factors for hungry bone syndrome in 84 patients with secondary hyperparathyroidism","volume":"6","author":"Latus","year":"2013","journal-title":"Int. J. Nephrol. Renovasc. Dis."},{"key":"ref_21","unstructured":"Cartwright, C., and Anastasopoulou, C. (2025). Hungry bone syndrome. StatPearls, StatPearls Publishing."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.afos.2022.03.004","article-title":"Hungry bone syndrome following parathyroidectomy for primary hyperparathyroidism in a developed country in the Asia Pacific: A cohort study","volume":"8","author":"Chandran","year":"2022","journal-title":"Osteoporos. Sarcopenia"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.1002\/hed.21119","article-title":"Elevated parathyroid hormone levels after parathyroidectomy for primary hyperparathyroidism","volume":"31","author":"Mizrachi","year":"2009","journal-title":"Head Neck"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1590\/2359-3997000000207","article-title":"Hypocalcemia development in patients operated for primary hyperparathyroidism: Can it be predicted preoperatively?","volume":"60","author":"Kaya","year":"2016","journal-title":"Arch. Endocrinol. Metab."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/cen.15268","article-title":"The effect of preoperative biochemical parameters on the development of hungry bone syndrome after surgery for primary hyperparathyroidism","volume":"103","author":"Hadi","year":"2025","journal-title":"Clin. Endocrinol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Xu, J., Kong, N., Bai, N., Zhang, Z., Cui, A., Tan, S., and Xu, Q. (2024). Identification of novel risk factors for postoperative severe hypocalcemia in patients with primary hyperparathyroidism undergoing parathyroidectomy: A case control study. BMC Endocr. Disord., 24.","DOI":"10.1186\/s12902-024-01620-6"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1177\/1457496920962601","article-title":"Role of vitamin D supplements in prevention of hungry bone syndrome after successful parathyroidectomy for primary hyperparathyroidism: A prospective study","volume":"110","author":"Salman","year":"2021","journal-title":"Scand. J. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s12957-021-02123-7","article-title":"Atypical parathyroid adenoma: Clinical and anatomical pathologic features","volume":"19","author":"Galani","year":"2021","journal-title":"World J. Surg. Oncol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e4565","DOI":"10.1210\/clinem\/dgab452","article-title":"Do patients with atypical parathyroid adenoma need close follow-up?","volume":"106","author":"Saponaro","year":"2021","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1016\/j.surg.2015.06.022","article-title":"The clinical importance of parathyroid atypia: Is long-term surveillance necessary?","volume":"158","author":"McCoy","year":"2015","journal-title":"Surgery"}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/7\/1041\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,30]],"date-time":"2026-03-30T12:27:08Z","timestamp":1774873628000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/7\/1041"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,30]]},"references-count":30,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["diagnostics16071041"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16071041","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,30]]}}}