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In the last 2 decades, patients with elevated serum PTH levels and normocalcemia in the absence of secondary causes have been increasingly described. Prevalence widely varies in the different cohorts; in particular:

•General population: in unselected, nonreferral populations, such as The Osteoporotic Fractures in Men (MrOS) study and Dallas Heart Study (DHS), the prevalence was of 0.4 and 0.6%, respectively [9]. Similarly, a survey carried out in 2010 in Pescopagano, a village in Southern Italy [10], detected NPHPT in 0.44% of an unselected sample of the whole community of adults.

•Postmenopausal women: in 5,202 women (aged 55–75 years) attending a population-based mammography screening, NPHPT was diagnosed in 1.4%. Indeed, at repeated examination, just one-third showed persistent normocalcemia and hyperparathyroidism [11], therefore revealing a prevalence overlapping that was defined in the general population.

•Postmenopausal osteoporotic women: the prevalence of NPHPT reported in a postmenopausal series evaluated for skeletal health was of 6% [12]. Similarly, a retrospective analysis of biochemical parameters in a Pakistan bone health screening panel detected NPHPT in 8.5% of cases [13]. Nonetheless, the diagnostic criteria used for NPHPT, measurement of the ionized calcium, and exclusion of all causes of SHPT differed throughout the series.