Hungry bone syndrome

Nishank Jain, Robert F. Reilly

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

Purpose of review In the United States, the number of parathyroidectomies among patients with chronic dialysis has remained stable in the last decade. A fall in serum calcium concentration is common postparathyroidectomy in patients with hyperparathyroidism, which usually resolves in 2-4 days. A severe drop in serum total calcium concentration less than 2.1 mmol/L and/or prolonged hypocalcemia for more than 4 days postparathyroidectomy is called hungry bone syndrome (HBS). Concomitant hypophosphatemia, hypomagnesemia, and hyperkalemia can be seen. Hypocalcemia and hypophosphatemia can persist for months to years. In contemporary clinical practice, HBS may be more commonly seen in patients with secondary compared to primary hyperparathyroidism. Preoperative radiological changes in bone, elevated serum alkaline phosphatase and parathyroid hormone (PTH) levels, and high numbers of osteoclasts on bone biopsy may identify patients at risk. Treatment consists of high-dose oral calcium and calcitriol supplementation. A low-dose pamidronate infusion 1-2 days prior to surgery may prevent HBS. Recent findings Recent in-vitro studies reported net calcium movement into bone because of a sudden fall in serum PTH level after a prolonged period of elevation. This supports a previous hypothesis that a sudden drop in serum PTH level after surgery results in the unopposed action of osteoblasts and influx of calcium into bone. Summary Incidence of HBS and its association with morbidity and mortality remains unclear in contemporary clinical practice. It is more common to encounter HBS in chronic dialysis patients with secondary hyperparathyroidism than those with primary hyperparathyroidism that undergo parathyroidectomies. Use of bisphosphonates to prevent HBS should be explored in future studies.

Original languageEnglish (US)
Pages (from-to)250-255
Number of pages6
JournalCurrent Opinion in Nephrology and Hypertension
Volume26
Issue number4
DOIs
StatePublished - Jul 1 2017

Fingerprint

Bone and Bones
Calcium
Parathyroid Hormone
Hypophosphatemia
Serum
Parathyroidectomy
pamidronate
Primary Hyperparathyroidism
Hypocalcemia
Dialysis
Hyperkalemia
Secondary Hyperparathyroidism
Hyperparathyroidism
Calcitriol
Diphosphonates
Osteoclasts
Osteoblasts
Alkaline Phosphatase
Morbidity
Biopsy

Keywords

  • chronic dialysis
  • hungry bone syndrome
  • hyperparathyroidism
  • hypocalcemia
  • parathyroidectomy

ASJC Scopus subject areas

  • Internal Medicine
  • Nephrology

Cite this

Hungry bone syndrome. / Jain, Nishank; Reilly, Robert F.

In: Current Opinion in Nephrology and Hypertension, Vol. 26, No. 4, 01.07.2017, p. 250-255.

Research output: Contribution to journalReview article

Jain, Nishank ; Reilly, Robert F. / Hungry bone syndrome. In: Current Opinion in Nephrology and Hypertension. 2017 ; Vol. 26, No. 4. pp. 250-255.
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