无症状原发性甲状旁腺功能亢进症（PHPT）可能会导致不利的骨架作用，其包括高骨重塑，减少的骨矿物质密度（BMD ），以及增加的骨折风险。甲状旁腺手术，彻底治疗的PHPT，已被证明能增加骨密度，似乎降低骨折的风险。当前指南推荐甲状旁腺手术患者的症状PHPT或无症状PHPT血钙> 1毫克/分升以上的正常上限，计算肌酐清除率<60 mL/min, osteoporosis, previous fracture, or age <50 yr. The type of operation performed (parathyroid exploration or minimally invasive procedure) and localizing studies to identify the abnormal parathyroid glands preoperatively should be individualized according to the skills of the surgeon and the resources of the institution. In patients who choose not to be treated surgically or who have contraindications for surgery, medical therapy should include a daily calcium intake of at least 1200 mg and maintenance of serum 25-hydroxyvitamin D levels of at least 20 ng/mL (50 nmol/L). Bisphosphonates and estrogens have been shown to provide skeletal benefits that appear to be similar to parathyroid surgery. Cinacalcet reduces serum calcium in PHPT patients with intractable hypercalcemia but has not been shown to improve BMD. It is not known whether any medical intervention reduces fracture risk in patients with PHPT. There are insufficient data on the natural history and treatment of normocalcemic PHPT to make recommendations for management of this disorder.
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