Bone & joints

Other nonneoplastic


Topic Completed: 1 June 2012

Minor changes: 21 October 2021

Copyright: 2003-2021,, Inc.

PubMed Search: hyperparathyroidism[title]bone

Dariusz Borys, M.D.
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Cite this page: Borys D Hyperparathyroidism. website. Accessed October 23rd, 2021.
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
Clinical features
Brown tumor of hyperparathyroidism
  • Solitary or multiple
  • Treatment: resect parathyroid tumor causing hyperparathyroidism or control hypophosphatemia medically (tumor rapidly regresses)
  • Gross description: large lytic lesion resembling bone tumor; brown due to hemorrhage
  • Microscopic description: numerous giant cells with interstitial hemorrhage, hemosiderin, microfractures, ingrowth of vascularized fibrous tissue with fibroblasts
  • Differential diagnosis:
    • Giant cell granuloma: different clinical history and laboratory findings
    • Giant cell tumor: more uniformly distributed giant cells, no interstitial hemorrhage, no fibroblastic stromal cells

Osteitis fibrosa cystica
  • Also called von Recklinghausens disease of bone
  • Micro description: increased bone cell activity, peritrabecular fibrosis, cystic brown tumors

Renal osteodystrophy
  • Skeletal changes of chronic renal disease
  • Increased osteoclastic bone resorption resembling osteitis fibrosa cystica
  • Associated with osteomalacia, osteosclerosis, growth retardation, osteoporosis
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
  • Thin bone cortices, loss of lamina dura around teeth
  • Rarely associated with brown tumor of hyperparathyroidism
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
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