Hyperparathyroidism: Surgery vs Bisphosphonates Timing

Primary hyperparathyroidism management hinges on distinguishing symptomatic from asymptomatic disease and assessing surgical candidacy according to established biochemical and densitometric thresholds. Parathyroidectomy remains the only curative intervention, durably correcting hypercalcemia, halting bone mineral density loss, and reducing nephrolithiasis risk. Bisphosphonates offer a temporary medical alternative for severe hypercalcemia or when surgery is contraindicated, but they fail to address the underlying glandular pathology or alter the natural history of parathyroid-driven bone resorption.