Hyperparathyroidism leads to excess osteoclast- mediated bone resorption and demineralization. This can be radiographically seen in the skull x-ray as salt and pepper appearance. It refers to the presence of multiple hyperlucent areas of decreased bone mass in the cranial vault. It is also referred to as the pepper-pot appearance. Image via: https://images.app.goo.gl/aqKw8F3cHprUr3UL9