Would you refer a patient for parathyroidectomy if they have normal calcium levels, mild hyperparathyroidism, and evidence of osteopenia?

It is important to be certain the patient has primary hyperparathyroidism by demonstrating by ultrasound or sestamibi scan the presence of an adenoma. Often patients with an elevated PTH and a normal calcium are also vitamin D deficient and have parathyroid hyperplasia. It is also important to rule out familial hypocalciuric hypercalcemia. Before I would recommend surgery it is helpful to know the age of the patient, the degree of osteopenia and at what skeletal sites are being affected since parathyroid hormone is more likely to increase loss of cortical bone i.e. wrist and hip compared to spine which is principally trabecular bone. I have seen many patients like this. I first will treat them with vitamin D and maintain a 25-hydroxyvitamin...

In such cases of normocalcemic hyperparathyroidism, I always order 24 hour urine for Calcium.