Non-neoplastic or metabolic disease

Author: Dariusz Borys, M.D. (see Authors page)

Revised: 3 October 2016, last major update June 2012

Copyright: (c) 2003-2016,, Inc.

PubMed Search: hyperparathyroidism[title]bone
Cite this page: Hyperparathyroidism. website. Accessed October 19th, 2018.
Definition / general
  • Only 25% have bone disease, usually bone pain
  • Presents in young to middle - aged adults with recurring kidney stones, peptic ulcer, nausea, vomiting, weakness, headaches
  • Affects entire skeleton, cortical bone more than medullary bone
  • Usually detected early, so osteitis fibrosa cystica (severe changes, also called Recklinghausen’s disease) is rare
  • Skeletal abnormalities with secondary hyperparathyroidism are typically mild

  • Parathyroid adenoma of one gland is most common
  • Rarely carcinoma or hyperplasia
Radiology description
  • Diffuse osteopenia
  • Specific pattern for fingers of cortical cutting cones (erosion of tufts of phalanges, subperiosteal cortical resorption, especially on radial side)
  • Marked hypercalcemia and hypophosphatemia
Gross description
Microscopic (histologic) description
  • Increased osteoclastic activity with tunneling of osteoclasts into bone matrix (dissecting resorption)
  • Also marked increase in bone formation and peritrabecular fibrosis
Differential diagnosis
  • Myelofibrosis: fibrous tissue diffusely throughout marrow, not around trabeculae
  • Paget's disease-acute phase: osteoclasts don’t tunnel, have more nuclei, different clinical presentation and laboratory findings