Preoperative Zoledronic Acid for the Prevention of Hungry Bone Syndrome After Parathyroidectomy in Primary Hyperparathyroidism: A Randomized Placebo-Controlled Trial
Primary result · HBSResult — go to the resultOdds ratio 1.06 95% CI 0.28–3.98Authors' conclusion
In patients with PHPT undergoing curative parathyroidectomy, a single preoperative infusion of ZA did not prevent HBS.
Study context
- Population
- Adults with PHPT and albumin-corrected serum calcium ≥11 mg/dL undergoing curative parathyroidectomy
- Participants
- 22 vs 23
- Comparison
- Preoperative zoledronic acid (ZA) 5 mg vs placebo
- ZAn = 22
- Placebon = 23reference
- Primary endpoint
- Incidence of hungry bone syndrome (HBS) after curative parathyroidectomy
Methodological detailssingle-blind, placebo-controlled, 1:1 randomisation, Daily inpatient biochemical monitoring until discharge, then 3 prespecified outpatient windows over 12 months
- Single-blind
- Placebo-controlled
- 1:1 randomisation
- Daily inpatient biochemical monitoring until discharge, then 3 prespecified outpatient windows over 12 months
Primary result
HBS
Odds ratio
1.06
95% CI 0.28–3.98
P = 0.928
Events by treatment group
ZA
6
events
Placebo
6
events
ZAvs Placebo
OR 1.06 (95% CI 0.28–3.98); P = 0.928
As reported in the abstract
Further findings
BMD (lumbar spine, femoral neck)
- BMD increased after parathyroidectomy in both groups; ZA gave no statistically significant additional benefit in lumbar spine or femoral neck BMD gain
CTX suppression
- CTX suppression more consistently pronounced with ZA, reflecting greater inhibition of bone resorption
Safety
- Adverse events more frequent with ZA, largely driven by more paresthesias
Original publication
Preoperative Zoledronic Acid for the Prevention of Hungry Bone Syndrome After Parathyroidectomy in Primary Hyperparathyroidism: A Randomized Placebo-Controlled Trial. Endocr Pract. Published 30 September 2026. doi:10.
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