Parathyroidectomy in the elderly is beneficial and safe with similar improvements in postoperative bone mineral density

•Parathyroidectomy is safe in the elderly population, 75 years and older, with comparable complication and recurrence rates.•Patients ≥75 experience improvements in bone mineral density for at least 3 years after parathyroidectomy.•Greater postoperative T-score improvement and reduction in postoperative fragility fractures were noted in patients <75.•T-scores for patients ≥75 remained persistently higher than preoperative scores at 4 years after surgery.