INTRODUCTION: Patients with primary hyperparathyroidism (PHPT) are prone to low bone mineral density (BMD). This study aimed to explore factors associated with improved bone health after parathyroidectomy (PTx). METHODS: We conducted a retrospective analysis of patients who underwent PTx for PHPT at our institution between 2016 and 2020. Patients who had a dual-energy X-ray absorptiometry (DEXA) scan before and after surgery were included. T score in the lumbar spine, femoral neck, hip, and radius were examined longitudinally. RESULTS: The cohort included 36 patients, predominantly White (80.6%) and female (97.2%), with an average age of 67 ± 8 ys. Before surgery, 25% were diagnosed with osteoporosis, 50% with osteopenia, and 25% had normal BMD. The mean preoperative calcium was 10.5 ± 0.7 mg/dL, and the median parathyroid hormone was 105 (75, 131) pg/mL. The median interval between the preoperative DEXA scan and surgery was 357 (134, 920) days. There was a significant improvement in the femoral neck T-score after surgery (-1.33 ± 1.05 presurgery versus -1.16 ± 1.19 postsurgery, P = 0.016), but not in other regions. A longer time between the preoperative DEXA scan and surgery was associated with a lower likelihood of T-score improvement after surgery (odds ratio = 0.92, 95% confidence interval 0.85 - 0.99). CONCLUSIONS: PTx improves BMD in the femoral neck of patient with PHPT. Early surgical intervention may be associated with better skeletal outcomes in PHPT.