Clinical manifestations, radiographic findings, and bone mineral measurements of 65 patients with primary hyperparathyroidism are reviewed. Fifty per cent presented with renal stones, and 38% had asymptomatic hypercalcemia. Advanced hyperparathyroid skeletal disease was not encountered. On conventional skeletal survey, 10% had minimal subperiosteal bone resorption limited to the phalanges. Radiographically visible osteopenia was uncommon and difficult to assess. By absorptometric analysis and fine-detail radiography, a majority were found to have demineralization and excessive bone resorption. These results illustrate the limitations of conventional radiography and underscore the need for newer more sensitive radiological techniques.