Hyperparathyroidism and bone health

Hyperparathyroidism can increase your risk of osteoporosis and broken bones.

Hyperparathyroidism is a condition where the parathyroid glands release too much parathyroid hormone. This can lead to high levels of calcium in the blood.

If the blood calcium level is low, more parathyroid hormone (PTH) is produced to raise calcium levels in the blood. Once the blood calcium is back to normal limits the release of PTH is then suppressed. PTH works by reducing the loss of calcium through the kidneys, by increasing calcium absorption from the gut and by causing the release of calcium from the bones.

How does hyperparathyroidism increase risk of osteoporosis?

If the parathyroid glands are producing too much parathyroid hormone then calcium will be released from bone stores. This has been shown to increase the risk of osteoporosis and broken bones by increasing the rate of bone turnover (the cycle of breakdown and renewal of bone). In some cases primary hyperparathyroidism may only come to light after a broken bone (fracture) has occurred.

If you have been diagnosed with hyperparathyroidism then a DXA (Dual energy x-ray absorptiometry) bone density scan may be performed to assess whether bone has been affected and your risk of breaking bones has increased.

Where surgery for primary hyperparathyroidism is performed the blood calcium levels reduce within 24 hours and bone density improvements can be expected over the following years. However if surgery is not performed then osteoporosis drug treatments such as bisphosphonates can be prescribed to reduce bone loss and your risk of breaking bones easily. Bone density can be monitored by the use of DXA and in some circumstances the bone density may be measured at the forearm as this may provide additional information that is useful for the doctor. Both parathyroidectomy and bisphosphonate treatment appear to have similar beneficial effect on the bones of patients with primary hyperparathyroidism.

If secondary hyperparathyroidism has occurred due to vitamin D deficiency then it is important to treat with vitamin D supplementation. Vitamin D is a fat soluble vitamin which regulates the formation of bone and the absorption of calcium from the intestine. The usual treatment would be to give calciferol which is the form of vitamin D made by sunlight on the skin.

Are there any osteoporosis medications I should avoid?

Interestingly parathyroid hormone can be used as a treatment for osteoporosis to reduce the risk of breaking bones (fractures) in the form of Forsteo or Preotact. However if you have been diagnosed with hyperparathyroidism then treatment with the parathyroid hormone would not be appropriate. All other treatments for osteoporosis are suitable unless there is kidney failure.

Should I keep taking calcium tablets or reduce my calcium intake?

If the blood calcium levels are high due to this condition your doctor may advise you to stop taking calcium supplements, at least until the condition is stabilised.

Content reviewed: November 2018

(Updated January 2022)