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

When your blood calcium climbs too high, it’s not just a lab number-it’s your bones weakening, your kidneys struggling, and your brain fog setting in. Hyperparathyroidism isn’t rare, but it’s often missed. In the U.S., about 100,000 people are diagnosed each year, mostly women over 50. Many live for years with fatigue, joint pain, and kidney stones, thinking it’s just aging or stress. But the real culprit? Overactive parathyroid glands pumping out too much hormone, pulling calcium straight out of your bones and into your bloodstream.

What’s Really Happening in Your Body?

Your four tiny parathyroid glands sit behind your thyroid in the neck. They’re in charge of calcium balance-nothing more, nothing less. When calcium drops, they release PTH (parathyroid hormone) to pull calcium from bones, boost absorption from food, and tell kidneys to hold onto it. Simple. Clean. Efficient.

In hyperparathyroidism, one or more of these glands go rogue. They stop listening. Even when your blood calcium is already too high, they keep pumping out PTH. That’s the red flag. Normal PTH should drop when calcium rises. If it doesn’t? That’s primary hyperparathyroidism-the most common form, making up 80-85% of cases.

The result? Calcium levels climb above 10.5 mg/dL (normal is 8.5-10.2). Your bones start crumbling. Your kidneys get clogged with calcium crystals. Your nerves get sluggish. And your brain? It feels like you’re running through syrup.

Bone Loss Isn’t Just About Age

Osteoporosis doesn’t always come from being sedentary or low in vitamin D. For many, it starts with hyperparathyroidism. The excess PTH turns your bone-building cells off and your bone-eating cells on. Studies show people with untreated hyperparathyroidism lose 2-4% of bone density every year at the hip and spine. That’s faster than most postmenopausal women lose bone.

DXA scans-used to check for osteoporosis-show clear damage. A T-score of -2.5 or lower means osteoporosis. In hyperparathyroidism, that score isn’t just a number. It’s a warning. Without treatment, fracture risk jumps by 30-50%. A simple fall can mean a broken hip, a long hospital stay, or worse.

And here’s the catch: even if you feel fine, your bones are still paying the price. Many patients don’t have pain until it’s too late. That’s why doctors now recommend screening for high calcium in adults over 65, especially women. Medicare started covering routine calcium tests in 2020-and diagnosis rates jumped 18% right away.

Surgery: The Only Real Cure

Medication can help manage symptoms. Drugs like cinacalcet lower PTH, and bisphosphonates slow bone loss. But they don’t fix the root problem. Only surgery can.

Parathyroidectomy-the removal of the overactive gland-is the gold standard. For single-gland disease (which happens in 85% of cases), a focused, minimally invasive procedure takes less than an hour. Most patients go home the same day. Recovery? Three to seven days. Success rates? 95-98% when done by experienced surgeons.

The key is finding the bad gland. That’s where imaging comes in. A sestamibi scan (using a radioactive tracer) finds the problem in 90% of cases. Ultrasound helps too. For tricky cases, 4D-CT scans give a 95% accuracy rate. Surgeons use these maps to make a small incision and remove just the faulty tissue-no big neck cut, no long hospital stay.

Who Needs Surgery? The Official Guidelines

Not everyone with high calcium needs surgery right away. But if you meet even one of these criteria, it’s strongly recommended:

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

Even if you have no symptoms, these signs mean your body is already being damaged. A 2023 study found untreated patients had 2-3 times higher fracture risk. That’s not a gamble worth taking.

What Happens After Surgery?

The moment the bad gland is removed, your body starts healing. Calcium levels usually drop within hours. Many patients say they feel better within days-less fatigue, clearer thinking, less pain.

Bone density starts improving, too. Within a year, most see a 3-5% gain in spine density. By year two, it’s 5-8%. That’s not just recovery-it’s reversal.

But there’s a catch. About 30-40% of patients get temporary low calcium after surgery. Your other parathyroid glands, which were dormant from overwork, need time to wake up. You’ll need calcium supplements for a few weeks-sometimes up to two months. It’s uncomfortable, but it’s normal.

A small number (5-10%) with multigland disease need lifelong monitoring. And about 15-20% of patients still feel tired or foggy after surgery, especially if their calcium was very high for years. That’s not a failed surgery-it’s evidence of long-term damage that takes longer to heal, if it heals at all.

Real People, Real Stories

On patient forums, the stories are consistent. One woman, 58, had kidney stones every year for a decade. She was told she was “just prone to them.” Her calcium was 11.8. PTH was 142. After surgery, her stones stopped. Her energy came back. “It felt like someone turned my brain back on,” she wrote.

Another man, 62, had chronic back pain. He thought it was arthritis. His DXA scan showed osteoporosis. After removal of a 1.5-gram adenoma, his bone density improved 6% in 18 months. He’s now hiking again.

But delays are common. Nearly half of patients wait 2-5 years for a diagnosis. They see three or more doctors. They’re misdiagnosed with depression, fibromyalgia, or chronic fatigue. That’s why knowing the signs matters.

What to Do If You Suspect It

If you’ve had unexplained fatigue, bone pain, frequent kidney stones, or brain fog-and you’re over 50, especially if you’re a woman-ask for two blood tests: serum calcium and PTH. Don’t rely on one test. Get them repeated a week apart. One high reading could be a fluke. Two highs? That’s a signal.

If your calcium is over 10.5 and your PTH is above 65 (or even “normal” but too high for your calcium), see an endocrinologist. Get imaging. Talk about surgery. Don’t wait for symptoms to get worse.

And if you’re already diagnosed? Avoid thiazide diuretics (common blood pressure meds) that raise calcium. Get enough vitamin D-low levels make things worse. Walk every day. Lift weights. Protect your bones.

The Future Is Faster, Smarter

New tools are making diagnosis and surgery better. AI is now analyzing sestamibi scans with 98% accuracy-cutting false positives by a third. A new drug called etelcalcetide, approved in early 2024, cuts PTH by 45% in trials. It’s not a cure, but it’s a bridge for those who can’t have surgery.

And surgical techniques keep improving. Intraoperative PTH testing gives results in under 10 minutes. If PTH drops more than half after removing the gland, you know it’s gone. That’s why success rates are now above 98% in high-volume centers.

The biggest barrier? Fear. Many patients worry about voice changes. But in experienced hands, the risk of nerve damage is less than 1%. That’s lower than the risk of a car accident on a short drive.

Don’t Ignore the Signs

Hyperparathyroidism isn’t scary because it’s rare. It’s scary because it’s common-and silent. It steals your energy, weakens your bones, and quietly damages your kidneys. But it’s fixable. Surgery isn’t a last resort. For most people, it’s the best first step.

You don’t have to live with fatigue because you think it’s just aging. You don’t have to accept kidney stones as your fate. And you don’t have to wait until you break a bone to act.

The fix is simple. The timing? It’s now.