BMD T-scor less than -2.5 at any site, with or without fragility fracture
Age < 50
Another thing to consider w/ surgery is whether they have renal stones.
Order SESTEMIBI scan if considering surgery - will show which glands are abnormal.
Can lead to hungry bone syndrome
Surveillance without surgery
Serum calcium level annually
BMD every 1-2 years (3 sites)
Good way to tell if surgery was successful when only going after 1 gland. PTH is cleared from body within 3 minutes or so, so surgeon can check PTH levels during surgery to decide whether another gland needs to be taken out. iPTH should decrease by more than 50% in successful cases.