Objective: To investigate the relationship between the number of parathyroid gland on ^99mTc-methoxyisobutylisonitrile (MIBI) single-photon emission computed tomography/computed tomography (SPECT/CT), preoperative laboratory parameters, peripheral blood inflammatory markers on bone hungry syndrome (HBS) after parathyroidectomy (PTX) in patients with renal secondary hyperparathyroidism (SHPT). Methods: The clinical and imaging data of 113 renal SHPT patients who underwent PTX in the Affiliated Jiangyin Hospital of Nantong University from Jun 2014 to Mar 2025 were retrospectively analyzed. The patients were divided into the HBS group and non-HBS group based on whether occurred HBS. Differences in various indices between the two groups were compared, multivariate logistic regression was used to analyze the influencing factors of HBS. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value. Results: Of all 113 patients, there were 63 patients in the HBS group and 50 patients in the non-HBS group. There were significant differences in age [(47.4±10.8) years vs. (54.1±9.2) years, P=0.001], preoperative alkaline phosphatase (ALP) [322.70(191.00, 636.10)U/L vs. 159.05(122.85, 221.88)U/L, P < 0.001], preoperative parathyroid hormone [171.10(114.00, 227.30)pmol/L vs. 120.95(98.40, 163.18)pmol/L, P=0.003], preoperative corrected calcium [2.43(2.24,2.53)mmol/L vs. 2.51(2.39,2.61)mmol/L, P=0.024], the number of SPECT/CT parathyroid gland≥4[74.6%(47/63) vs. 38.0%(19/50), P<0.001], and prognostic nutritional index (PNI) [49.95(46.20,52.00) vs. 46.60(43.74,50.10), P=0.003] between the two groups. Multivariate logistic regression showed that preoperative ALP(OR=1.005,95%CI:1.002-1.009,P=0.002), the number of SPECT/CT parathyroid gland≥4(OR=3.166,95%CI:1.235-8.113,P=0.016), and PNI(OR=1.112,95%CI:1.013-1.221,P=0.026) were independent risk factors for HBS. The ROC curve determined the optimal cut-off values of preoperative ALP and PNI as 278.0 U/L and 44.925. The combination of preoperative ALP≥278.0 U/L, the number of SPECT/CT parathyroid gland≥4 and PNI≥44.925 achieved sensitivity of 98.4% for diagnosing HBS, which were higher than individual indicator (all P < 0.05). Conclusion: The preoperative ALP, the number of SPECT/CT parathyroid gland≥4, and PNI were independent influencing factors for HBS, combined preoperative ALP≥278.0 U/L, the number of SPECT/CT parathyroid gland≥4 and PNI≥44.925 demonstrates high sensitivity in diagnosing HBS, thus have good clinical value.