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Median total parathyroid weight on 4D-CT was 270mg, and mean change in BMD at the LS was 2.4±4.3%. The increase in BMD was best predicted by higher preoperative serum calcium (p=0.01), greater estimated parathyroid weight (p=0.001), sestamibi avidity (p=0.03), and increased time between DXA scans (p=0.03) in the multivariable model (R =0.79, p0.0001). In PHPT, higher preoperative serum calcium, parathyroid gland weight on imaging, and sestamibi avidity are associated with greater increases in BMD after curative PTX. These findings sug