Context: Primary Hyperparathyroidism (PHPT) has a prevalence of 0.86% and is associated with increased risk of nephrolithiasis and osteoporosis. PHPT may also be associated with an increased risk of cardiovascular disease and mortality. Objective: To identify risk factors for nephrolithiasis, osteoporosis and mortality in PHPT. Design: Retrospective cohort study. Setting: University teaching hospital. Patients: PHPT presenting between 2006 – 2014 (n = 611). Main outcome measures: Assessment of nephrolithiasis, osteoporosis and mortality. Results: 13.9% of PHPT patients had nephrolithiasis. Most had already documented stone disease and only 4.7% of asymptomatic patients screened for renal stones had calculi identified, not very dissimilar to the rate in the non-PHPT population. Younger age (P < 0.001) and male gender (P = 0.003) were the only independent predictors of nephrolithiasis. 48.4% of patients with DXA data had osteoporosis (223/461). Older age (P < 0.001), lower BMI (P = 0.002) and lower creatinine (P = 0.006) were independently associated with a diagnosis of osteoporosis. Higher PTH was independently associated with lower Z-score at the hip (P = 0.009), but otherwise calcium and PTH were not associated with lower Z-score. Mortality in PHPT was associated with older age (P < 0.008), social deprivation (P = 0.028) and adjusted calcium (P = 0.009) but not independently with PTH at diagnosis. Conclusions: Screening for nephrolithiasis has a low yield, particularly in lower risk patients. Osteoporosis is only minimally associated with biochemical indices of PHPT. Mortality is associated with higher calcium (and possibly vitamin D deficiency) but not PTH.