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  • • End-stage skeletal manifestation of severe hyperparathyroidism

    • Rarely seen now in industrialized societies

    • Consists of bone cysts, osteoporosis, and brown tumors (result of excessive osteoclastic bone resorption)


  • • Historically, 15% of hyperparathyroid patients presented with bone disease

Symptoms and Signs

  • • Pain

    • Pathologic fractures

    • Paraplegia (secondary to vertebral collapse)

Laboratory Findings

  • • Elevated serum calcium

    • Elevated intact parathyroid hormone level

Imaging Findings

  • • Bone radiographs demonstrate osteoporosis, fractures, cysts

    • Subperiosteal resorption of the radial aspect of the index and long fingers

    • Increased uptake on bone scan

Rule Out

  • • Parathyroid carcinoma

  • • Bone scan

  • • Only effective treatment is the localization and excision of all abnormal parathyroid tissue



  • • All patients with osteitis fibrosa cystica should have parathyroidectomy


  • • Calcium and vitamin D supplementation postoperatively to aid in bone remineralization

Treatment Monitoring

  • • Monitor serum calcium and intact parathyroid hormone level


  • • Reversal of bone loss is common after parathyroidectomy, but recovery of bone mass to normal is rare


Agarwal G et al. Recovery pattern of patients with osteitis fibrosa cystica in primary hyperparathyroidism after successful parathyroidectomy. Surgery. 2002;132:1075.  [PubMed: 12490858]
Raeburn CD et al. End-stage skeletal manifestations of severe hyperparathyroidism. Surgery. 2002;132:896.  [PubMed: 12464877]

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