Objective: The prevalence of abdominal aortic calcification (AAC) in primary hyperparathyroidism (PHPT) is unknown. We assessed both prevalence and severity of AAC in PHPT postmenopausal women. Methods: In this study 70 PHPT postmenopausal women and 70 age-and sex-matched controls were enrolled. Each participant underwent biochemical evaluation, lateral spine radiograph, bone mineral density (BMD) measurement (lumbar, femoral, radial sites), and kidney ultrasound. Lateral lumbar films were analyzed in the region of L1-L4 vertebrae and the Kauppila score (a semi-quantitative grading system) was used to assess the severity of AAC. Results: There were no differences regarding demographic and cardiovascular risk factors in the two groups. PHPT patients had higher prevalence of kidney stones (30% vs 7%, P = 0.0008) and lower radial BMD values (0.558 ± 0.071 vs 0.588 ± 0.082 g/cm 2 , P < 0.05) compared with controls. PHPT patients showed higher prevalence of AAC (31 vs 18, P = 0.03), with more severe calcifications (Kauppila score 7.35 ± 6.1 vs 5.05 ± 3.5, P = 0.007). PHPT patients with AAC were older and had been suffering from the disease for a longer period compared with those without ACC. Moreover, PHPT patients with severe AAC had mean higher serum parathyroid hormone levels compared with patients with moderate or mild calcifications. In PHPT patients with AAC, multiple regression analysis, adjusted for age and years since diagnosis, showed that only parathyroid hormone significantly correlated with Kauppila score. Conclusion: We found a higher prevalence and severity of AAC in PHPT related to parathyroid hormone effect.