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Hungry Bone Syndrome Following Parathyroidectomy: a Comprehensive Systematic Review of Risk Factors

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Indian Journal of Surgery Aims and scope Submit manuscript

Abstract

This study aim s, primarily, to identify the incidence of hungry bone syndrome in parathyroidectomy and, secondarily, to systematically determine the factors predisposing to hungry bone syndrome. PubMed, Embase and Cochrane databases were searched for the data extraction. Human studies reporting risk factors for developing HBS in patients undergoing parathyroidectomy for primary (PHP), secondary (SHP) or tertiary hyperparathyroidism (THP) were included. Newcastle–Ottawa score was used to assess the quality of studies. PROSPERO registration CRD42022293002. This systematic review comprised 2598 patients in the 18 included comparative studies. The overall incidence of HBS following parathyroidectomy in PHP, SHP and THP was 15.9% (8.6–39.1, CI 95%), 43.6% (20.6–87.8, CI 95%) and 12.4% (6.03–32.4, CI 95%), respectively. Younger age group (PHP and SHP), thyroidectomy along with parathyroidectomy (PHP), longer duration of surgery (PHP), larger and heavier resected parathyroids (PHP and SHP), previous dialysis (SHP), longer duration of dialysis (SHP), preoperative cinacalcet (THP) and bisphosphonates use (protective effect) (PHP and THP), calcium levels close to normal (SHP), higher values of parathormone (PHP and SHP), > 90% drop in PTH after surgery (PHP and SHP), raised ALP (PHP and SHP), higher osteocalcin (PHP and SHP), lower albumin (PHP and SHP), higher TRAP 5b (SHP), higher P1NP (PHP), BALP (PHP) and testosterone (PHP) were predictors of HBS. The risk factors for developing hypocalcaemia and HBS should be actively monitored. A complete and accurate recording of the parameters is encouraged among the clinicians to understand the HBS further.

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Data Availability

The data used for this systematic review is available with the corresponding author. The data shall be provided upon reasonable request.

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Authors and Affiliations

  1. Department of Otolaryngology and Head Neck Surgery, All India Institute of Medical Sciences, Raipur, India

    Rupa Mehta

  2. Department of Head and Neck Oncology, All India Institute of Medical Sciences, Raipur, India

    Karthik Nagaraja Rao

  3. All India Institute of Medical Sciences, Raipur, India

    Nitin M. Nagarkar

  4. Department of Endocrinology, All India Institute of Medical Sciences, Raipur, India

    Amritava Ghosh

  5. Department of Orthopedics, All India Institute of Medical Sciences, Raipur, India

    Harshal Sakale

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  1. Rupa Mehta
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  2. Karthik Nagaraja Rao
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  3. Nitin M. Nagarkar
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  4. Amritava Ghosh
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  5. Harshal Sakale
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Contributions

Conceived and designed the analysis: RM, KNR, NMN, AG, HS.

Collected the data: KNR.

Data synthesis: KNR, RM, NMN.

Performed the analysis: KNR, RM, NMN.

Manuscript writing: KNR, RM.

Manuscript review and inputs: RM, KNR, NMN, HS, AG.

Corresponding author

Correspondence to Karthik Nagaraja Rao.

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The Manuscript was presented in Asia Pacific Thyroid Society 2023 under Best Paper award category.

Level of Evidence—III

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Mehta, R., Rao, K.N., Nagarkar, N.M. et al. Hungry Bone Syndrome Following Parathyroidectomy: a Comprehensive Systematic Review of Risk Factors. Indian J Surg (2023). https://doi.org/10.1007/s12262-023-03853-6

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