We have previously reported a case of a 36-year-old woman who was diagnosed with primary hyperparathyroidism following initial skeletal abnormalities in the hand phalanges and calcaneus revealed by quantitative ultrasound (QUS). Successful parathyroid adenoma surgery resulted in progressive increase of bone mineral density and QUS parameters within 6 months, 1 year and 2 years of follow-up. Now, 5 years after the last measurement and at the onset of her menopause, the study was repeated. It has shown further increase in some ultrasonic and densitometric parameters but decrease in others. This discrepancy could be associated with the early influence of perimenopause on trabecular bone. Based on the current report one can conclude that peripheral QUS used on the hand phalanges and calcaneus is a useful tool for the diagnosis and monitoring of skeletal alterations due to parathyroid dysfunction. Moreover, it can detect early changes associated with perimenopause.