ABSTRACT Background Bone mineral density (BMD) measurement at the lumbar spine, femoral neck, total hip, and distal 1/3 radius is recommended for patients with primary hyperparathyroidism (PHPT). Osteoporosis at any site justifies surgery. The distal 1/3 radius is often neglected. This study evaluated the prevalence of distal 1/3 radius measurement, the proportion of osteoporosis at this site alone, and BMD changes 1 year post‐parathyroidectomy in patients with PHPT. Methods A total of 548 patients who underwent parathyroidectomy for PHPT between 2016 and 2024 in University Hospital Center of Nantes (France) were reviewed. Patients without pre‐surgery BMD measurements at the lumbar spine or the femoral neck were excluded. BMD was assessed via dual x‐ray absorptiometry before and 12‐months after surgery. Results Four hundred patients (mean age 63.3 ± 12.3 years, 80.5% female, and 86.2% menopausal) were included. Mean baseline serum calcium was 2.76 ± 0.19 mmol/L; median PTH was 99.2 pg/mL 76.1; 138.7. Osteoporosis was present in 47.0% of patients. Distal 1/3 radius BMD was measured in 46.2%, identifying 11.4% with forearm‐only osteoporosis. They were younger (60.6 ± 13.9 vs. 67.1 ± 10.2 years, p = 0.048), less frequently menopausal (66.7% vs. 95.9%, p = 0.001) and had higher calcium levels (2.88 ± 0.18 vs. 2.73 ± 0.20 mmol/L, p = 0.002) than the other osteoporotic patients. After surgery, BMD increased significantly at the lumbar spine (+0.06 g/cm 2 ) and the total hip (+0.03 g/cm 2 ), in a similar way to other osteoporotic patients. Conclusion After measuring distal 1/3 radius BMD, performed in < 50% of PHPT patients, it was identified that 11.4% patients had forearm‐only osteoporosis, who could have a bone benefit from surgery. These findings emphasize the importance of systematic measurement during PHPT evaluation. Trial Registration NCT05469087
Loison et al. (Sun,) studied this question.