Osteocalcin is an Independent Predictor for Hungry Bone Syndrome After Parathyroidectomy

  • Wen-Ching Ko
  • Chien-Liang Liu
  • Jie-Jen Lee
  • Tsang-Pai Liu
  • Chih-Jen Wu
  • Shih-Ping ChengEmail author
Original Scientific Report



Hungry bone syndrome is characterized by prolonged and severe hypocalcemia following parathyroidectomy. Previously, we reported that preoperative alkaline phosphatase is a major factor predicting prolonged hospital stay. Nonetheless, some patients with low alkaline phosphatase levels presented with hungry bone syndrome, suggesting that additional factors may play a role.


From September 2010 to December 2017, consecutive dialysis patients who underwent parathyroidectomy for secondary hyperparathyroidism were analyzed. Length of hospital stay was used as a surrogate marker for postoperative bone hunger.


A total of 260 patients were included in the study. The median postoperative hospital stay was 3 days, and 69 (27%) patients had a stay longer than 3 days. Multivariate logistic regression analysis revealed that alkaline phosphatase (odds ratio [OR] = 1.005), osteocalcin (OR = 1.001), and subtotal parathyroidectomy (OR = 0.061) were associated with prolonged hospital stay. Multivariate linear regression analysis indicated that age (β = − 0.170), alkaline phosphatase (β = 0.430), and osteocalcin (β = 0.166) were correlated with the length of stay. After surgery, the median osteocalcin level increased from 264 to 478 ng/mL (P < 0.001).


Alkaline phosphatase is the main predictor of hungry bone syndrome after parathyroidectomy, and preoperative osteocalcin is an additional independent predictor. Patients with a high osteocalcin level may prone to have a higher demand for calcium supplementation.



This work was supported by research grants (MOST-107-2314-B-195-001-MY3) from the Ministry of Science and Technology of Taiwan and MacKay Memorial Hospital (MMH-10912). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.


This study was funded by the Ministry of Science and Technology of Taiwan (Grant Number MOST-107-2314-B-195-001-MY3) and MacKay Memorial Hospital (Grant Number MMH-10912).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Approved by the Institutional Review Board and Ethics Committee of MacKay Memorial Hospital.


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Copyright information

© Société Internationale de Chirurgie 2019

Authors and Affiliations

  • Wen-Ching Ko
    • 1
  • Chien-Liang Liu
    • 1
  • Jie-Jen Lee
    • 1
  • Tsang-Pai Liu
    • 1
  • Chih-Jen Wu
    • 2
    • 3
  • Shih-Ping Cheng
    • 1
    • 3
    Email author
  1. 1.Department of SurgeryMacKay Memorial Hospital and Mackay Medical CollegeTaipeiTaiwan
  2. 2.Division of Nephrology, Department of Internal MedicineMacKay Memorial Hospital and Mackay Medical CollegeTaipeiTaiwan
  3. 3.Department of Pharmacology, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan

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