Predictive Risk Score for Postparathyroidectomy Hungry Bone Syndrome in Patients With Secondary Hyperparathyroidism

J Clin Endocrinol Metab. 2024 Feb 20;109(3):603-610. doi: 10.1210/clinem/dgad636.


Purpose: Secondary hyperparathyroidism (SHPT) frequently affects patients with end-stage renal disease. Hungry bone syndrome (HBS) is a common complication among patients who undergo parathyroidectomy for SHPT and may cause prolonged hospitalization or require intensive care. The objective of this study is to develop a scoring system to stratify patients according to their risk of developing HBS.

Methods: A retrospective cohort study was performed using the US Renal Data System (2010-2021). Univariable and multivariable logistic regression models were developed and weighted β-coefficients from the multivariable model were used to construct a risk score for the development of HBS. Positive and negative predictive values were assessed.

Results: Of 17 074 patients who underwent parathyroidectomy for SHPT, 19.4% developed HBS. Intensive care unit admission was more common in patients who developed HBS (33.5% vs 24.6%, P < .001). On multivariable logistic regression analysis, younger age, renal osteodystrophy, longer duration of dialysis, longer duration of kidney transplant, and higher Elixhauser score were significantly associated with HBS. A risk score based on these clinical factors was developed, with a total of 6 possible points. Rates of HBS ranged from 8% in patients with 0 points to 44% in patients with 6 points. The risk score had a poor positive predictive value (20.3%) but excellent negative predictive value (89.3%) for HBS.

Conclusion: We developed a weighted risk score that effectively stratifies patients by risk for developing HBS after parathyroidectomy. This tool can be used to counsel patients and to identify patients who may not require postoperative hospitalization.

Keywords: end-stage renal disease; hungry bone syndrome; parathyroid glands; parathyroidectomy; predictive risk score; secondary hyperparathyroidism.

MeSH terms

  • Bone Diseases, Metabolic* / etiology
  • Calcium
  • Humans
  • Hyperparathyroidism, Secondary* / epidemiology
  • Hyperparathyroidism, Secondary* / etiology
  • Hyperparathyroidism, Secondary* / surgery
  • Hypocalcemia* / complications
  • Hypocalcemia* / etiology
  • Kidney Failure, Chronic* / complications
  • Kidney Failure, Chronic* / epidemiology
  • Kidney Failure, Chronic* / surgery
  • Parathyroid Hormone
  • Parathyroidectomy / adverse effects
  • Retrospective Studies
  • Risk Factors


  • Parathyroid Hormone
  • Calcium