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Role of vitamin D supplements in prevention
of hungry bone syndrome for primary
hyperparathyroidism
Introduction
• Primary hyperparathyroidism affects up to 1% of adults1
• Parathyroidectomy is the main treatment, effectively correcting
hypercalcemia and associated complications like osteoporosis
and renal failure.
• However, it's not without risks, with postoperative complications
including hematoma, nerve injury, and hypocalcemia 2
1. Best CAE, Krishnan R.Medicine 2017;96(43):e7255
2. Harvey A. Surgical endocrinopathies. New York: Springer, 2015, pp. 163–171.
Introduction
• Hunger Bone Syndrome (HBS) is a rare complication characterized
by severe hypocalcemia following parathyroidectomy.
• Risk factors include old age, high preoperative calcium and PTH
levels, and rapid decline in PTH post-surgery, low vitamin D level
• Recent studies suggest preoperative correction of vitamin D levels
may reduce HBS incidence.
Rolighed L, Rejnmark L. J Clin Endocrinol Metab 2014;99(3):1072–1080
Research methods
Participants
• 102 consecutive adult patients with primary hyperparathyroidism
due to benign adenoma
• Preoperative vitamin D levels less than 29 ng/mL1.
Exclusion
• Patients with specific conditions such as multiglandular disease,
suspected or proven carcinoma, inadequate fall of intraoperative
PTH, renal impairment, and pregnancy or lactation were excluded
from the study.
1. Holick MF: Medical progress: Vitamin D deficiency. N Engl J Med 2007;357:266–281
Research methods
Randomization and control study
• 102 patient
• computer-
generated
random
sequence
• 102 patient
• Computer-generated random
sequence
• Group I: 52 patients
• Not receive preoperative
vitamin D
• Group II 50 patient: received
cholecalciferol supplementation
either daily (1000–2000 IU) or
weekly (50000 IU) for up to 6 months
• Vitamin D levels >20 ng/mL
• Group IIa = 25 patients
• Vitamin D levels >30 ng/mL
• Group IIb = 25 patients
Research methods
Surgical Techniques
• Intraoperative rapid PTH assays were used to assess the adequacy of the
surgery, with a decline of >50% within 10 minutes considered successful
Data Collection
• Preoperative assessments included history, physical exam, serum calcium,
phosphorus, magnesium, 25-hydroxyvitamin D levels, imaging, and bone
mineral density via DEXA.
• Postoperatively, patients were followed for 4 weeks to evaluate changes in
labs and the occurrence of hungry bone syndrome (HBS).
• HBS was defined as severe hypocalcemia <8.2 mg/dL and
hypophosphatemia persisting beyond postoperative day 4.
• HBS was treated with IV/oral calcium and calcitriol until calcium levels
improved
Research methods
Study Outcomes:
• Primary: Assess the effect of preoperative vitamin D correction on
the incidence of postoperative HBS.
• Secondary: Determine the vitamin D cutoff associated with higher
HBS risk and the association between preoperative labs and HBS.
Results The baseline characteristics of study participants
Results The association between HBS and preoperative data
Results The change in laboratory parameters during follow-up.
- Serum phosphorus increased, and serum alkaline phosphatase level decreased
significantly in group IIa and group IIb from day 1 to day 30
Results Association between the incidence of HBS and study’s groups
p = 0.22
Conclusion
• Patients with HBS had significantly lower preoperative 25-
hydroxyvitamin D levels than those without HBS
• Other risk factors associated with HBS included older age,
higher baseline levels of serum calcium, phosphorus, alkaline
phosphatase, magnesium, and bone mineral density.
• Patients who received vitamin D supplements showed better
improvement in calcium and alkaline phosphatase levels
after surgery, there was no significant reduction in the incidence
of HBS compared to the control group.
Limitation
• Lack of data on duration of vitamin D deficiency, adenoma
volume, bone turnover markers, and sample size calculations
• Larger randomized trials are still needed to better assess the
potential role of preoperative vitamin D in parathyroidectomy
outcomes

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Role of vitamin D supplements in prevention of hungry bone syndrome for primary hyperparathyroidism.pptx

  • 1. Role of vitamin D supplements in prevention of hungry bone syndrome for primary hyperparathyroidism
  • 2. Introduction • Primary hyperparathyroidism affects up to 1% of adults1 • Parathyroidectomy is the main treatment, effectively correcting hypercalcemia and associated complications like osteoporosis and renal failure. • However, it's not without risks, with postoperative complications including hematoma, nerve injury, and hypocalcemia 2 1. Best CAE, Krishnan R.Medicine 2017;96(43):e7255 2. Harvey A. Surgical endocrinopathies. New York: Springer, 2015, pp. 163–171.
  • 3. Introduction • Hunger Bone Syndrome (HBS) is a rare complication characterized by severe hypocalcemia following parathyroidectomy. • Risk factors include old age, high preoperative calcium and PTH levels, and rapid decline in PTH post-surgery, low vitamin D level • Recent studies suggest preoperative correction of vitamin D levels may reduce HBS incidence. Rolighed L, Rejnmark L. J Clin Endocrinol Metab 2014;99(3):1072–1080
  • 4. Research methods Participants • 102 consecutive adult patients with primary hyperparathyroidism due to benign adenoma • Preoperative vitamin D levels less than 29 ng/mL1. Exclusion • Patients with specific conditions such as multiglandular disease, suspected or proven carcinoma, inadequate fall of intraoperative PTH, renal impairment, and pregnancy or lactation were excluded from the study. 1. Holick MF: Medical progress: Vitamin D deficiency. N Engl J Med 2007;357:266–281
  • 5. Research methods Randomization and control study • 102 patient • computer- generated random sequence • 102 patient • Computer-generated random sequence • Group I: 52 patients • Not receive preoperative vitamin D • Group II 50 patient: received cholecalciferol supplementation either daily (1000–2000 IU) or weekly (50000 IU) for up to 6 months • Vitamin D levels >20 ng/mL • Group IIa = 25 patients • Vitamin D levels >30 ng/mL • Group IIb = 25 patients
  • 6. Research methods Surgical Techniques • Intraoperative rapid PTH assays were used to assess the adequacy of the surgery, with a decline of >50% within 10 minutes considered successful Data Collection • Preoperative assessments included history, physical exam, serum calcium, phosphorus, magnesium, 25-hydroxyvitamin D levels, imaging, and bone mineral density via DEXA. • Postoperatively, patients were followed for 4 weeks to evaluate changes in labs and the occurrence of hungry bone syndrome (HBS). • HBS was defined as severe hypocalcemia <8.2 mg/dL and hypophosphatemia persisting beyond postoperative day 4. • HBS was treated with IV/oral calcium and calcitriol until calcium levels improved
  • 7. Research methods Study Outcomes: • Primary: Assess the effect of preoperative vitamin D correction on the incidence of postoperative HBS. • Secondary: Determine the vitamin D cutoff associated with higher HBS risk and the association between preoperative labs and HBS.
  • 8. Results The baseline characteristics of study participants
  • 9. Results The association between HBS and preoperative data
  • 10.
  • 11. Results The change in laboratory parameters during follow-up. - Serum phosphorus increased, and serum alkaline phosphatase level decreased significantly in group IIa and group IIb from day 1 to day 30
  • 12. Results Association between the incidence of HBS and study’s groups p = 0.22
  • 13. Conclusion • Patients with HBS had significantly lower preoperative 25- hydroxyvitamin D levels than those without HBS • Other risk factors associated with HBS included older age, higher baseline levels of serum calcium, phosphorus, alkaline phosphatase, magnesium, and bone mineral density. • Patients who received vitamin D supplements showed better improvement in calcium and alkaline phosphatase levels after surgery, there was no significant reduction in the incidence of HBS compared to the control group.
  • 14. Limitation • Lack of data on duration of vitamin D deficiency, adenoma volume, bone turnover markers, and sample size calculations • Larger randomized trials are still needed to better assess the potential role of preoperative vitamin D in parathyroidectomy outcomes

Editor's Notes

  1. active vitamin D (calcitriol) 0.25–1 µg