Table 1

Prevalence and natural history of NPHPT

StudyPatient cohortVitamin D cut-off (nmol/L)eGFR cut-off (mL/min)NPHPT prevalence (%)Natural history
Population - based studies on asymptomatic patients
Kontogeorgos et al 14 (WHO MONICA, Sweden)General population aged 25–64 years (n=608)>50Not provided11.0One person progressed to hypercalcaemia
None developed end-organ involvement (13-year follow-up)
Lundgren et al 15 16
Postmenopausal women (n=5202)Not excludedNot provided (serum Cr >150 μmol/L)0.5When reassessed at 8.9 years there was a similar prevalence of NPHPT
Serum calcium increased by 0.04±0.10 mmol/L
Cusano et al 17
Unselected community-dwelling men aged ≥65 years (n=2364)>50>600.4Not followed-up
Cusano et al 17
General population aged 18–65 years
>50>603.1one person progressed to hypercalcaemia
None developed end-organ involvement
29 patients no longer met the criteria for NPHPT at follow-up (8 years)
García-Martín et al 18 (Spain)Postmenopausal women (n=100)>75>606.0No progression (1-year follow-up)
Berger et al 19
(CaMos, Canada)
General population aged 31–97(n=1871)>50Not excluded16.7Not followed-up
Rejnmark et al 38 (DOPS, Denmark)Postmenopausal women (n=2016)Not excluded>6017.0One person progressed to hypercalcaemia (16-year follow-up)
Referral population of high-risk patients*
Lowe et al 6
Referred patients to metabolic bone unit aged 32–78 years (NPHPT, n=37)>50>4019% progressed to hypercalcaemia 40% developed further end-organ involvement
(mean follow-up of 3.1±0.3 years)
Maruani et al 10 (France)Referred patients aged 55±11 years to metabolic unit (n=178)>15>5019.1Data on progression not available
Šiprová et al 11
(Czech Republic)
Referred patients aged 26–85 years with suspected PHPT
(NPHPT, n=187)
>50Not provided19% progressed to hypercalcaemia (6-year follow-up—most progressed within 2 years)
Tordjman et al 13
Referred patients aged 60.5±10.5 years with suspected PHPT
(NPHPT, n=32)
>50Not provided12 required surgery
No progression in the rest
(mean follow-up of 4.1±3 years)
Marques et al 21
Referred women aged 62.4±10.5 years to exclude osteoporosis(n=156)>75>408.9Data on progression not available
  • *Patients who are at a higher risk of metabolic bone disease or already have adverse bone and renal outcomes like osteoporosis, fragility fractures or renal calculi.

  • eGFR, estimated glomerular filtration rate; NPHPT, normocalcaemic hyperparathyroidism; PHPT, primary hyperparathyroidism.