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Charopoulos et al. [33] examined the effects of PHPT in the skeleton by using peripheral quantitative CT comparing NPHPT with HPHPT. Catabolic effects were detected in both groups, but were more pronounced in hypercalcemic subjects than in normocalcemic subjects. Cortical geometric properties were also adversely affected in NPHPT subjects; however, trabecular properties were preserved in NPHPT [33]. There was no difference in the trabecular bone score (TBS) between NPHPT and HPHPT patients. However, there was a reduction in the TBS of patients with asymptomatic HPHPT that was related to PTH levels but had no repercussion on bone mass. Higher levels of PTH seem to be responsible for this alteration in microarchitecture texture [34].

Considering the clinical setting, osteoporosis and fragility fractures were diagnosed in 57 and 11% of a series of NPHPT patients [31]. In agreement with these data, 15% of NPHPT patients had a previous history of fractures compared to 10.8% of NPHPT patients in an independent series [32].