{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,11]],"date-time":"2026-10-11T13:52:18Z","timestamp":1791726738236,"version":"4.3.4"},"reference-count":153,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"VICTOR BABES UNIVERSITY OF MEDICINE AND PHARMACY TIMISOARA"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Secondary hyperparathyroidism (SHPT) in chronic kidney disease often necessitates parathyroidectomy (PTX), but this definitive treatment can precipitate hungry bone syndrome (HBS)\u2014a profound, prolonged hypocalcemia caused by the rapid skeletal uptake of minerals after surgery. HBS results from the abrupt cessation of parathyroid hormone (PTH)-driven bone resorption while bone formation continues, leading to intensive mineral deposition (mainly calcium) into chronically demineralized bone. Clinically, HBS ranges from asymptomatic biochemical disturbances to life-threatening hypocalcemia with tetany, seizures, and\/or cardiac arrhythmias. This illustrative review synthesizes current knowledge of HBS pathogenesis and management in the context of SHPT. We detail how the high-turnover bone remodeling state of SHPT (osteitis fibrosa cystica) creates an expansive unmineralized osteoid pool that avidly mineralizes post-PTX. We also explore molecular mechanisms (e.g., RANKL\/OPG dysregulation, Wnt\/\u03b2-catenin activation, osteocyte-driven signals, and calcium-sensing receptor effects) that underpin this process. Key preoperative risk factors for HBS include very elevated PTH and alkaline phosphatase levels, large skeletal calcium deficits, younger patient age, and total PTX. We outline the typical postoperative course of HBS, phased from immediate acute hypocalcemia to a nadir and gradual recovery. Prevention and management strategies are emphasized, centered on vigilant monitoring and aggressive calcium and calcitriol supplementation, with preoperative optimization (e.g., vitamin D loading, calcimimetics) to mitigate severity. By enhancing risk stratification and perioperative care, clinicians can improve outcomes and safely navigate patients through this challenging complication of endocrine surgery.<\/jats:p>","DOI":"10.3390\/jcm14197104","type":"journal-article","created":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T09:41:02Z","timestamp":1760002862000},"page":"7104","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Hungry Bone Syndrome After Parathyroidectomy for Secondary Hyperparathyroidism: Pathogenesis and Contemporary Clinical Considerations"],"prefix":"10.3390","volume":"14","author":[{"given":"Adina","family":"Coman","sequence":"first","affiliation":[{"name":"Researching Future Surgery II Research Center, Department X, Discipline of General Surgery II, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"},{"name":"Department X, Discipline of General Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1772-3910","authenticated-orcid":false,"given":"Cristi","family":"Tarta","sequence":"additional","affiliation":[{"name":"Researching Future Surgery II Research Center, Department X, Discipline of General Surgery II, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4320-229X","authenticated-orcid":false,"given":"Marco","family":"Marian","sequence":"additional","affiliation":[{"name":"Researching Future Surgery II Research Center, Department X, Discipline of General Surgery II, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1728-3552","authenticated-orcid":false,"given":"Daian Ionel","family":"Popa","sequence":"additional","affiliation":[{"name":"Doctoral School, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1634-2836","authenticated-orcid":false,"given":"Sorin","family":"Olariu","sequence":"additional","affiliation":[{"name":"Department X, Discipline of General Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihai","family":"Rosu","sequence":"additional","affiliation":[{"name":"Department of Medicine, Discipline of Surgery I, Vasile Goldi\u015f Western University, Liviu Rebreanu Boulevard, No. 86, 310414 Arad, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7708-7314","authenticated-orcid":false,"given":"Diana","family":"Utu","sequence":"additional","affiliation":[{"name":"Department II, Discipline of Pharmacology-Pharmacotherapy, Faculty of Pharmacy, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9814-9561","authenticated-orcid":false,"given":"Florina","family":"Buleu","sequence":"additional","affiliation":[{"name":"Department VI, Discipline of Internal Medicine and Ambulatory Care, Prevention and Cardiovascular Recovery, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anca-Monica","family":"Macovei-Oprescu","sequence":"additional","affiliation":[{"name":"Gastroenterology, Agrippa Ionescu Emergency Clinical Hospital, Bucharest, Romania, University of Medicine and Pharmacy Carol Davila Bucharest, Eroii Sanitari Bvd., no. 8, Sector 5, 300041 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2520-7636","authenticated-orcid":false,"given":"Dorin","family":"Novacescu","sequence":"additional","affiliation":[{"name":"Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5755-179X","authenticated-orcid":false,"given":"Flavia","family":"Zara","sequence":"additional","affiliation":[{"name":"Department II of Microscopic Morphology, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3045-6282","authenticated-orcid":false,"given":"Marius","family":"Murariu","sequence":"additional","affiliation":[{"name":"Department X, Discipline of General Surgery I, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy Timisoara, E. Murgu Square, No. 2, 300041 Timisoara, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"184321","DOI":"10.1155\/2015\/184321","article-title":"International Burden of Chronic Kidney Disease and Secondary Hyperparathyroidism: A Systematic Review of the Literature and Available Data","volume":"2015","author":"Hedgeman","year":"2015","journal-title":"Int. J. Nephrol."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Wang, Y., Liu, J., Fang, Y., Zhou, S., Liu, X., and Li, Z. (2024). Estimating the Global Prevalence of Secondary Hyperparathyroidism in Patients with Chronic Kidney Disease. Front. 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