Primary hyperparathyroidism (PHPT) is the most common cause of chronic hypercalcemia. With advancing age, the incidence increases for both sexes, reaching 196 per 100鈥�000 person-years for women and 95 per 100鈥�000 person-years for men by 70 to 79 years of age.1 Approximately 80% of individuals with PHPT initially lack symptoms such as nephrolithiasis, kidney dysfunction, gastrointestinal upset, and neuropsychiatric effects. However, even among asymptomatic individuals, PHPT accelerates bone turnover, predisposing them to osteoporosis and fragility fractures; the morbidity and mortality of these fractures are also most frequent among elderly individuals.2 Surgery remains the only definitive treatment option for PHPT. However, the most recent (2014) National Institutes of Health consensus guidelines3 suggest that in the absence of symptomatic PHPT鈥攕erum calcium level more than 1 mg/dL above normal (upper limit, 10.3 mg/dL; to convert to mmol/L, multiply by 0.25); evidence of osteoporosis or vertebral fractures; estimated glomerular filtration rate less than 60 mL/min/1.73 m2; and/or hypercalciuria (>400 mg/d)鈥攕urgery should only be considered when the asymptomatic individual is younger than 50 years.3