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The clinical picture of hyperparathyroidism has gone toward deep modifications in the last few decades, and currently this disease is more frequently asymptomatic. So, the que – stion is raising concerning which patients have to be ope – rated, due to the substantial benignity of the disease and the lack of well defined symptoms. Classical indications for surgery have been formulated more than a decade ago and are as follows: calcemia higher than 3 mmol/L, previous episode of life threatening hypercalcaemia, reduced creati -, nine clearance, nephrolithiasis, hypercalciuria, osteoporosis. In the last years other indications have been added, on the basis of clinical and epidemiological studies that have con – tributed to broaden our knowledgement on the evolution and complicances of the disease. Among these, the following data have to been kept in mind: history of previous atrau – matic fractures, vertebral osteopenia (Z-score <-2), vitamin D deficiency, perimenopausal status, neuromuscular or psy – chical disturbances.