Normal adjusted Ca and high PTH, 25(OH)D ≥ 50 nmol/L Excluded cases with renal insufficiency (GFR < 40 mL/min/1.73 m2), liver disease; significant hypercalciuria > 350 mg/24 h, thiazide diuretic or lithium use, other metabolic bone diseases (eg, Paget disease). Here, PTH is linked to Paget disease.