［Abstract］ Objective: To investigate the relationship between the number of parathyroid gland on 99mTc-methoxyisobutvlisonitrile (MIBI) SPECT/CT, preoperative laboratory parameters and inflammatory markers on bone hungry syndrome (HBS) after parathyroidectomy (PTX) in patients with renal secondary hyperparathyroidism (SHPT). Methods: From Jun 2014 to Mar 2025, 113 renal SHPT patients who underwent PTX were enrolled in Affiliated Jiangyin Hospital of Nantong University. The patients were divided into HBS group and in non-HBS group based on whether occurred HBS. Differences in various indices between the two groups were compared, univariate binary logistic regression was used to analyze the influencing factors of HBS. The optimal cutoff values were evaluated receiver operating characteristic(ROC) curve analysis. Results: Of all 113 patients, there were 63 patients in HBS group and 50 patients in non-HBS group. The age ((47.4±10.8) vs. (54.1±9.2) years, P=0.001), preoperative alkaline phosphatase(ALP) (322.70 (191.00, 636.10) vs. 159.05 (122.85, 221.88) U/L, P<0.001), preoperative parathyroid hormone(171.10 (114.00, 227.30) vs. 120.95 (98.40, 163.18) pmol/L, P=0.003), preoperative corrected calcium((2.41±0.22) 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=0.003) and prognostic nutritional index (PNI)((49.01±4.95) vs. 46.00 (43.74, 50.10), P=0.003). Multivariate logistic regression showed that preoperative ALP (OR=1.005, 95%CI: 1.001-1.009, P=0.011), the number of SPECT/CT parathyroid gland≥4 (OR=2.992, 95%CI: 1.152-7.770, P=0.024) and PNI (OR=1.102, 95%CI: 1.003-1.212, P=0.044) were independent risk factors for HBS, with an optimal cutoff value of the preoperative ALP and PNI were 278.0 U/L, 44.925, respectively. 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.