Hyperparathyroidism: High Calcium, Bone Loss, and When Surgery Is Needed

When your blood calcium stays too high for too long, your body starts breaking itself down-slowly, silently, and often without warning. This isn’t just a lab number out of range. It’s your bones thinning, your kidneys forming stones, your brain feeling foggy, and your energy vanishing. For many people, this is hyperparathyroidism.

What’s Really Going On Inside Your Body?

Your four tiny parathyroid glands, nestled behind your thyroid in the neck, are meant to keep calcium balanced. They release parathyroid hormone (PTH) when calcium drops. PTH tells your bones to release calcium, your intestines to absorb more from food, and your kidneys to hold onto it instead of peeing it out.

In hyperparathyroidism, one or more of these glands go rogue. They keep pumping out PTH even when calcium is already high. That’s like having a faucet turned on full blast while the sink is already overflowing.

The result? Blood calcium climbs above 10.5 mg/dL-well past the normal range of 8.5 to 10.2. At the same time, PTH levels stay elevated, often above 65 pg/mL. That’s the key diagnostic sign: calcium up, PTH up. Not down. Not normal. Up.

This isn’t rare. About 100,000 Americans are diagnosed each year. Women are three times more likely to get it than men. And it’s more common in African-American populations. Many people live for years without knowing, their symptoms dismissed as aging, stress, or depression.

How High Calcium Eats Away at Your Bones

Your bones aren’t just scaffolding-they’re storage units for calcium. When PTH stays high, your bones are constantly tapped. Osteoclasts, the cells that break down bone, go into overdrive. Over time, this leads to measurable bone loss.

DXA scans show that people with untreated primary hyperparathyroidism lose 2-4% of bone density each year at the hip and spine. That’s faster than most postmenopausal women lose bone from estrogen drop. After five years, that’s a 10-20% loss. Your fracture risk jumps by 30-50% compared to someone your age without the condition.

It’s not just about fragility. Many patients report deep, constant bone pain-especially in the back, hips, or legs. Some mistake it for arthritis or fibromyalgia. Others notice they’re losing height, or their posture is changing. These aren’t normal signs of aging. They’re red flags.

Surgery Isn’t Just an Option-It’s the Only Cure

Medications can help manage symptoms, but they don’t fix the root problem. Cinacalcet lowers PTH a bit. Bisphosphonates slow bone loss. But neither stops the glands from overproducing hormone.

The only cure? Removing the faulty gland(s). Parathyroidectomy. It’s a targeted, minimally invasive procedure that takes 1-2 hours. In experienced hands, success rates hit 95-98% for single-gland disease-the most common form.

Preoperative imaging is critical. A sestamibi scan finds the bad gland in 90% of cases. Ultrasound adds another 85% accuracy. In complex cases, 4D-CT gives near-perfect detail. Surgeons don’t just open your neck and guess-they know exactly where to go.

You don’t need to wait until you’re in crisis. The 2022 International Workshop guidelines say surgery should be considered if:

• Your calcium is more than 1 mg/dL above normal
• Your kidney function is down (creatinine clearance under 60 mL/min)
• Your bone density is T-score -2.5 or worse (osteoporosis)
• You’re under 50 years old

Even if you feel fine, these criteria matter. Studies show untreated patients have 2-3 times higher fracture risk. And the longer you wait, the harder it is to reverse damage.

What Happens After Surgery?

Most people go home the same day. Recovery is quick-3 to 7 days on average. Within weeks, energy returns. Brain fog lifts. Bone pain fades.

Your calcium will drop after surgery. That’s normal. In fact, it’s a good sign. But it can cause temporary hypocalcemia-tingling, numbness, muscle cramps. About 30-40% of patients need calcium and vitamin D supplements for a few weeks. A few with multigland disease may need them longer.

Bone density starts to recover. Within a year, lumbar spine density improves by 3-5%. By two years, it’s up 5-8%. That’s not just a number-it means you’re less likely to break a hip or spine.

But not everyone feels 100% better. About 15-20% of patients still report fatigue or brain fog after surgery. Why? Because prolonged high calcium can damage nerves, kidneys, or even the brain itself. The earlier you act, the better your chance of full recovery.

Why So Many People Are Diagnosed Too Late

One patient said it best: “I was misdiagnosed with depression for seven years.”

Symptoms like fatigue, memory trouble, irritability, and frequent kidney stones are vague. Doctors often test for depression, anxiety, or chronic fatigue before checking calcium. It’s not negligence-it’s how common these symptoms are.

A 2023 survey found 47% of patients waited 2-5 years between first symptoms and diagnosis. One in three saw three or more doctors. That delay is costly. Every extra year with high calcium means more bone loss, more kidney damage, more risk.

Routine blood work can catch this early. If you’re over 50, or have a family history, ask your doctor to check your calcium and PTH during your next annual visit. It’s a simple blood test. No fasting needed.

What You Can Do Right Now

If you’ve been told your calcium is high or you’re struggling with unexplained fatigue, bone pain, or kidney stones:

• Get a second blood test. One high calcium reading isn’t enough. You need two elevated levels at least a week apart.
• Ask for your PTH level. If it’s normal or high while calcium is high, that’s hyperparathyroidism.
• Request a DXA scan if you’re over 50 or have risk factors.
• See an endocrine surgeon if surgery is recommended. Volume matters-surgeons who do 50+ parathyroidectomies a year have far better outcomes.
• Take vitamin D if you’re deficient. But don’t take extra calcium supplements unless told to. Too much can make things worse.
• Walk daily. Weight-bearing exercise helps protect bone density.
• Avoid thiazide diuretics (like hydrochlorothiazide) if you can. They raise calcium levels.

What’s Changing in 2025

New tools are making diagnosis faster and surgery safer. AI now helps interpret sestamibi scans with 98% accuracy, cutting down false positives. A new drug, etelcalcetide, is showing promise in early trials for primary hyperparathyroidism-though it’s not yet approved for this use.

Intraoperative PTH testing is now standard. Surgeons check PTH levels 10 minutes after removing the gland. If it drops by more than 50%, they know they got it all. That’s why cure rates are so high in top centers.

Genetic testing is now recommended for anyone diagnosed under 40 or with a family history. About 10% of cases are tied to inherited syndromes like MEN1, which also raise risk for tumors in the pancreas or pituitary.

Still, the biggest barrier isn’t technology-it’s awareness. Too many people suffer for years because no one connects the dots.

Real Stories, Real Outcomes

A 58-year-old teacher in Ohio had chronic fatigue and kidney stones for eight years. Her calcium was 11.8. PTH was 142. She was told she was “just stressed.” After surgery, her energy returned. Her kidney stones stopped. Her bone density improved by 6% in a year.

A 45-year-old man in Texas had back pain and memory lapses. His DXA scan showed osteoporosis at age 45. He thought he was too young. Surgery fixed it. He’s now hiking again.

One Reddit user wrote: “I felt like my brain was underwater. After surgery, it was like someone turned on the lights.”

These aren’t outliers. They’re the rule-if you act in time.