{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T02:31:05Z","timestamp":1760236265773,"version":"build-2065373602"},"reference-count":55,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T00:00:00Z","timestamp":1636070400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Primary hyperparathyroidism (pHPT) has been reported to have a higher prevalence in sickle cell disease (SCD) patients, including a high rate of recurrence following surgery. However, most patients are asymptomatic at the time of diagnosis, with surprisingly infrequent hypercalciuria, raising the issue of renal calcium handling in SCD patients. We conducted a retrospective study including (1) 64 hypercalcemic pHPT non-SCD patients; (2) 177 SCD patients, divided into two groups of 12 hypercalcemic pHPT and 165 non-pHPT; (3) eight patients with a diagnosis of familial hypocalciuric hypercalcemia (FHH). Demographic and biological parameters at the time of diagnosis were collected and compared between the different groups. Determinants of fasting fractional excretion of calcium (FeCa2+) were also analyzed in non-pHPT SCD patients. Compared to non-SCD pHPT patients, our data show a similar ionized calcium and PTH concentration, with a lower plasmatic calcitriol concentration and a lower daily urinary calcium excretion in pHPT SCD patients (p &lt; 0.0001 in both cases). Fasting FeCa2+ is also surprisingly low in pHPT SCD patients, and thus inadequate to be considered hypercalcemia, recalling the FHH phenotype. FeCa2+ is also low in the non-pHPT SCD control group, and negatively associated with PTH and hemolytic biomarkers such as LDH and low hemoglobin. Our data suggest that the pHPT biochemical phenotype in SCD patients resembles the FHH phenotype, and the fasting FeCa2+ association with chronic hemolysis biomarkers strengthens the view of a potential pharmacological link between hemolytic by-products and calcium reabsorption, potentially through a decreased calcium-sensing receptor (CaSR) activity.<\/jats:p>","DOI":"10.3390\/jcm10215179","type":"journal-article","created":{"date-parts":[[2021,11,5]],"date-time":"2021-11-05T10:33:09Z","timestamp":1636108389000},"page":"5179","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Primary Hyperparathyroidism in Homozygous Sickle Cell Patients: A Hemolysis-Mediated Hypocalciuric Hypercalcemia Phenotype?"],"prefix":"10.3390","volume":"10","author":[{"given":"Edmat Akhtar","family":"Khan","sequence":"first","affiliation":[{"name":"Service de N\u00e9phrologie, Universit\u00e9 de Lorraine, CHRU-Nancy, 54500 Vand\u0153uvre-l\u00e8s-Nancy, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lynda","family":"Cheddani","sequence":"additional","affiliation":[{"name":"Unit\u00e9 HTA, Pr\u00e9vention et Th\u00e9rapeutique Cardiovasculaires, Assistance Publique\u2014H\u00f4pitaux de Paris, H\u00f4pital H\u00f4tel Dieu, 75004 Paris, France"},{"name":"Centre de Diagnostic et de Th\u00e9rapeutique, H\u00f4tel-Dieu, Universit\u00e9 de Paris, 75006 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camille","family":"Saint-Jacques","sequence":"additional","affiliation":[{"name":"Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique\u2014H\u00f4pitaux de Paris, H\u00f4pital Tenon, 75020 Paris, France"},{"name":"Unit\u00e9 Mixte de Recherche (UMR) S 1155, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Sorbonne Universit\u00e9, H\u00f4pital Tenon, 75020 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4169-0680","authenticated-orcid":false,"given":"Rosa","family":"Vargas-Poussou","sequence":"additional","affiliation":[{"name":"Centre d\u2019Investigation Clinique, Centre de R\u00e9f\u00e9rence des Maladies R\u00e9nales H\u00e9r\u00e9ditaires de l\u2019Enfant et de l\u2019Adulte, Assistance Publique\u2014H\u00f4pitaux de Paris, H\u00f4pital Europ\u00e9en Georges Pompidou, 75015 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Frochot","sequence":"additional","affiliation":[{"name":"Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique\u2014H\u00f4pitaux de Paris, H\u00f4pital Tenon, 75020 Paris, France"},{"name":"Unit\u00e9 Mixte de Recherche (UMR) S 1155, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Sorbonne Universit\u00e9, H\u00f4pital Tenon, 75020 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Remi","family":"Chieze","sequence":"additional","affiliation":[{"name":"Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique\u2014H\u00f4pitaux de Paris, H\u00f4pital Tenon, 75020 Paris, France"},{"name":"Unit\u00e9 Mixte de Recherche (UMR) S 1155, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Sorbonne Universit\u00e9, H\u00f4pital Tenon, 75020 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emmanuel","family":"Letavernier","sequence":"additional","affiliation":[{"name":"Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique\u2014H\u00f4pitaux de Paris, H\u00f4pital Tenon, 75020 Paris, France"},{"name":"Unit\u00e9 Mixte de Recherche (UMR) S 1155, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Sorbonne Universit\u00e9, H\u00f4pital Tenon, 75020 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginie","family":"Avellino","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Interne, Centre de R\u00e9f\u00e9rence de la Dr\u00e9panocytose, Assistance Publique\u2014H\u00f4pitaux de Paris, H\u00f4pital Tenon, 75020 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francois","family":"Lionnet","sequence":"additional","affiliation":[{"name":"Service de M\u00e9decine Interne, Centre de R\u00e9f\u00e9rence de la Dr\u00e9panocytose, Assistance Publique\u2014H\u00f4pitaux de Paris, H\u00f4pital Tenon, 75020 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2756-2287","authenticated-orcid":false,"given":"Jean-Philippe","family":"Haymann","sequence":"additional","affiliation":[{"name":"Service des Explorations Fonctionnelles Multidisciplinaires, Assistance Publique\u2014H\u00f4pitaux de Paris, H\u00f4pital Tenon, 75020 Paris, France"},{"name":"Unit\u00e9 Mixte de Recherche (UMR) S 1155, Institut National de la Sant\u00e9 et de la Recherche M\u00e9dicale, Sorbonne Universit\u00e9, H\u00f4pital Tenon, 75020 Paris, France"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2021,11,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1016\/S0140-6736(10)61029-X","article-title":"Sickle-cell disease","volume":"376","author":"Rees","year":"2010","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Da Guarda, C.C., Yahou\u00e9d\u00e9hou, S.C.M.A., Santiago, R.P., dos Santos Neres, J.S., de Lima Fernandes, C.F., Aleluia, M.M., Figueiredo, C.V.B., Fiuza, L.M., Carvalho, S.P., and de Oliveira, R.M. (2020). Sickle cell disease: A distinction of two most frequent phenotypes (HbSS and HbSC). PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0228399"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1561","DOI":"10.1056\/NEJMra1510865","article-title":"Sickle cell disease","volume":"376","author":"Piel","year":"2017","journal-title":"N. Engl. J. Med."},{"key":"ref_4","first-page":"429","article-title":"The tubular reabsorption of phosphate in sickle-cell nephropathy","volume":"55","year":"1978","journal-title":"Clin. Sci. Mol. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"254","DOI":"10.3181\/00379727-168-41269","article-title":"Serum phosphate abnormalities in sickle cell anemia","volume":"168","author":"Smith","year":"1981","journal-title":"Proc. Soc. Exp. Biol. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"552","DOI":"10.1159\/000013518","article-title":"Renal reabsorption of phosphate in children with sickle cell anemia","volume":"19","author":"Annobil","year":"1999","journal-title":"Am. J. Nephrol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"120","DOI":"10.4314\/wajm.v24i2.28180","article-title":"Serum magnesium, phosphate and calcium in Nigerian children with sickle cell disease","volume":"24","author":"Oladipo","year":"2005","journal-title":"West. Afr. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2267","DOI":"10.1002\/pbc.25188","article-title":"Abnormalities in renal tubular phosphate handling in children with sickle cell disease","volume":"61","author":"Raj","year":"2014","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Antwi-Boasiako, C., Kusi-Mensah, Y.A., Hayfron-Benjamin, C., Aryee, R., Boatemaah Dankwah, G., Kwawukume, L.A., and Owusu Darkwa, E. (2019). Total serum magnesium levels and calcium-to-magnesium ratio in sickle cell disease. Medicina, 55.","DOI":"10.3390\/medicina55090547"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1002\/ajh.20187","article-title":"Serum ionized magnesium levels and ionized calcium-to-magnesium ratios in adult patients with sickle cell anemia","volume":"77","author":"Zehtabchi","year":"2004","journal-title":"Am. J. Hematol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"648","DOI":"10.2215\/CJN.09790913","article-title":"Prevalence and correlates of metabolic acidosis among patients with homozygous sickle cell disease","volume":"79","author":"Maurel","year":"2014","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"188","DOI":"10.1016\/0002-9343(82)90809-9","article-title":"Hyperkalemic hyperchloremic acidosis in sickle cell hemoglobinopathies","volume":"72","author":"Batlle","year":"1982","journal-title":"Am. J. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"828","DOI":"10.1111\/bjh.15270","article-title":"Risk factors for vitamin D deficiency in sickle cell disease","volume":"181","author":"Han","year":"2018","journal-title":"Br. J. Haematol."},{"key":"ref_14","first-page":"350","article-title":"Vitamin D in children and adolescents with sickle cell disease: An integrative review","volume":"33","author":"Vicente","year":"2015","journal-title":"Rev. Paul. Pediatr."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1177\/000456329303000108","article-title":"Serum calcium, parathyroid hormone, and vitamin D status in children and young adults with sickle cell disease","volume":"30","author":"Mohammed","year":"1993","journal-title":"Ann. Clin. Biochem."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1002\/ajh.21085","article-title":"Sickle cell bone disease: Response to vitamin D and calcium","volume":"83","author":"Adewoye","year":"2008","journal-title":"Am. J. Hematol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"538","DOI":"10.1111\/j.1365-2141.2010.08458.x","article-title":"Vitamin D deficiency and chronic pain in sickle cell disease","volume":"153","author":"Osunkwo","year":"2011","journal-title":"Br. J. Haematol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1038\/nrendo.2017.104","article-title":"Primary hyperparathyroidism","volume":"14","author":"Walker","year":"2018","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3263951","DOI":"10.1155\/2016\/3263951","article-title":"Amelioration of sickle cell pain after parathyroidectomy in two patients with concurrent hyperparathyroidism: An interesting finding","volume":"2016","author":"Muthu","year":"2016","journal-title":"Case Rep. Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e537","DOI":"10.1542\/peds.2006-0337","article-title":"Primary hyperparathyroidism mimicking vaso-occlusive crises in sickle cell disease","volume":"118","author":"Krishnamoorthy","year":"2006","journal-title":"Pediatrics"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Denoix, E., Bomahou, C., Clavier, L., Ribeil, J.-A., Lionnet, F., Bartolucci, P., Courbebaisse, M., Pouchot, J., and Arlet, J.-B. (2020). Primary hyperparathyroidism in sickle cell disease: An unknown complication of the disease in adulthood. J. Clin. Med., 9.","DOI":"10.3390\/jcm9020308"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1016\/j.bone.2012.10.005","article-title":"Relationship between vitamin D deficiency and bone fragility in sickle cell disease: A cohort study of 56 adults","volume":"52","author":"Arlet","year":"2013","journal-title":"Bone"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"604","DOI":"10.7326\/0003-4819-150-9-200905050-00006","article-title":"A new equation to estimate glomerular filtration rate","volume":"150","author":"Levey","year":"2009","journal-title":"Ann. Intern. Med."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.beem.2018.05.004","article-title":"Familial hypocalciuric hypercalcemia and related disorders","volume":"32","author":"Lee","year":"2018","journal-title":"Best. Pract. Res. Clin. Endocrinol. Metab."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1879","DOI":"10.1681\/ASN.2012030323","article-title":"Deficiency of the calcium-sensing receptor in the kidney causes parathyroid hormone-independent hypocalciuria","volume":"23","author":"Toka","year":"2012","journal-title":"J. Am. Soc. Nephrol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3561","DOI":"10.1210\/jc.2014-1413","article-title":"Guidelines for the management of asymptomatic primary hyperparathyroidism: Summary statement from the fourth international workshop","volume":"99","author":"Bilezikian","year":"2014","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1001\/jamasurg.2016.2310","article-title":"The American association of endocrine surgeons guidelines for definitive management of primary hyperparathyroidism","volume":"151","author":"Wilhelm","year":"2016","journal-title":"JAMA Surg."},{"key":"ref_28","first-page":"333","article-title":"Hyperparathyroidism","volume":"69","author":"Taniegra","year":"2004","journal-title":"Am. Fam. Physician"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1007\/s00198-016-3716-2","article-title":"Primary hyperpara.athyroidism: Review and recommendations on evaluation, diagnosis, and management. A Canadian and international consensus","volume":"28","author":"Khan","year":"2017","journal-title":"Osteoporosis Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"362","DOI":"10.3399\/bjgp20X710717","article-title":"Hyperparathyroidism (primary) NICE guideline: Diagnosis, assessment, and initial management","volume":"70","author":"Jawaid","year":"2020","journal-title":"Br. J. Gen. Pract."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1599","DOI":"10.1172\/JCI110194","article-title":"Jejunal ileal adaptation to alterations in dietary calcium: Changes in calcium magnesium absorption pathogenetic role of parathyroid hormone, 1,25-dihydroxyvitamin D","volume":"67","author":"Norman","year":"1981","journal-title":"J. Clin. Investig."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"438","DOI":"10.1093\/ajcn\/67.3.438","article-title":"Dietary protein intake and urinary excretion of calcium: A cross-sectional study in a healthy Japanese population","volume":"67","author":"Itoh","year":"1998","journal-title":"Am. J. Clin. Nutr."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1172\/JCI111995","article-title":"Evidence for alteration of the vitamin D-endocrine system in blacks","volume":"76","author":"Bell","year":"1985","journal-title":"J. Clin. Investig."},{"key":"ref_34","first-page":"49","article-title":"Urinary calcium in normal adults and in patients with renal stones: An interracial study","volume":"5","author":"Modlin","year":"1967","journal-title":"Investig. Urol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1002\/jbmr.5650080912","article-title":"Demonstration of a difference in urinary calcium, not calcium absorption, in black and white adolescents","volume":"8","author":"Bell","year":"1993","journal-title":"J. Bone Miner. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"68","DOI":"10.5049\/EBP.2008.6.2.68","article-title":"Kidney and calcium homeostasis","volume":"6","author":"Jeon","year":"2008","journal-title":"Electrolyte Blood Press."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1126\/science.1114245","article-title":"The beta-glucoronidase klotho hydrolyzes and activates the TRPV5 channel","volume":"310","author":"Chang","year":"2005","journal-title":"Science"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"9805","DOI":"10.1073\/pnas.0803223105","article-title":"Removal of sialic acid involving Klotho causes cell-surface retention of TRPV5 channel via binding to galectin-1","volume":"105","author":"Cha","year":"2008","journal-title":"Proc. Natl. Acad. Sci. USA"},{"key":"ref_39","first-page":"229","article-title":"FGF23 promotes renal calcium reabsorption through the TRPV5 channel","volume":"33","author":"Andrukhova","year":"2014","journal-title":"EMBO J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"867","DOI":"10.4158\/EP11022.OR","article-title":"Low urine calcium excretion in African American patients with primary hyperparathyroidism","volume":"17","author":"Taha","year":"2011","journal-title":"Endocr. Pract."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"756","DOI":"10.2215\/CJN.08511109","article-title":"Glomerular hyperfiltration in adult sickle cell anemia: A frequent hemolysis associated feature","volume":"5","author":"Haymann","year":"2010","journal-title":"Clin. J. Am. Soc. Nephrol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"201","DOI":"10.3324\/haematol.2011.050336","article-title":"Association between Hemolysis and Albuminuria in Adult with Sickle Cell Anemia","volume":"97","author":"Day","year":"2012","journal-title":"Haematologica"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"750","DOI":"10.1172\/JCI89741","article-title":"Intravascular hemolysis and the pathophysiology of sickle cell disease","volume":"127","author":"Kato","year":"2017","journal-title":"J. Clin. Investig."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2279","DOI":"10.1182\/blood-2005-06-2373","article-title":"Lactate dehydrogenase as a biomarker of hemolysis-associated nitric oxide resistance, priapism, leg ulceration, pulmonary hypertension, and death in patients with sickle cell disease","volume":"107","author":"Kato","year":"2006","journal-title":"Blood"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"F1337","DOI":"10.1152\/ajprenal.00273.2015","article-title":"Ways of calcium reabsorption in the kidney","volume":"310","author":"Moor","year":"2016","journal-title":"Am. J. Physiol. Renal. Physiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1042\/cs0760081","article-title":"Determinants of the serum concentration of 1,25-dihydroxyvitamin D in primary hyperparathyroidism","volume":"76","author":"Lalor","year":"1989","journal-title":"Clin. Sci."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/0169-6009(89)90006-8","article-title":"Determinants for serum 1,25-dihydroxycholecalciferol in primary hyperparathyroidism","volume":"5","author":"Mosekilde","year":"1989","journal-title":"Bone Miner."},{"key":"ref_48","first-page":"137","article-title":"Circulating concentrations of 1,25-dihydroxyvitamin D3 in patients with primary hyperparathyroidism","volume":"1","author":"Thakker","year":"1986","journal-title":"Bone Miner."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1159\/000486060","article-title":"Physiology of the calcium-parathyroid hormone-vitamin D axis","volume":"50","author":"Goltzman","year":"2018","journal-title":"Front. Horm. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"2171","DOI":"10.1182\/blood.V126.23.2171.2171","article-title":"Plasma FGF23 is a biomarker for left ventricular hypertrophy and mortality in adults with sickle cell anemia chronic kidney disease","volume":"126","author":"Liu","year":"2015","journal-title":"Blood"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"e33","DOI":"10.3324\/haematol.2016.150987","article-title":"Carboxy-terminal fragment of fibroblast growth factor 23 induces heart hypertrophy in sickle cell disease","volume":"102","author":"Courbebaisse","year":"2017","journal-title":"Haematologica"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"77","DOI":"10.5049\/EBP.2008.6.2.77","article-title":"Kidney and phosphate metabolism","volume":"6","author":"Choi","year":"2008","journal-title":"Electrolyte Blood Press."},{"key":"ref_53","unstructured":"Gardner, D., and Shoback, D. (2011). Greenspan\u2019s Basic & Clinical Endocrinology, McGraw Hill. [9th ed.]."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/978-1-4615-9167-2_19","article-title":"The phosphaturic action of PTH in the steady state in patients with normal and impaired renal function","volume":"128","author":"Kleerekopper","year":"1980","journal-title":"Adv. Exp. Med. Biol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1016\/j.jocd.2008.11.005","article-title":"Prevalence of cortical osteoporosis in mild and severe primary hyperparathyroidism and its relationship with bone markers and vitamin D status","volume":"12","author":"Bandeira","year":"2009","journal-title":"J. Clin. Densitom."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/21\/5179\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:26:26Z","timestamp":1760167586000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/21\/5179"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,11,5]]},"references-count":55,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["jcm10215179"],"URL":"https:\/\/doi.org\/10.3390\/jcm10215179","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2021,11,5]]}}}