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Therapy of hypoparathyroidism with intact parathyroid hormone

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Abstract

Summary

Hypoparathyroidism, a disorder characterized by low parathyroid hormone (PTH), is generally treated with oral calcium and vitamin D supplementation. We investigated the effects of PTH(1–84) treatment in 30 hypoparathyroid subjects for 24 months. PTH(1–84) treatment in hypoparathyroidism significantly reduced supplemental calcium and 1,25-dihydroxyvitamin D requirements without generally altering serum and urinary calcium levels.

Introduction

Hypoparathyroidism, a disorder characterized by low PTH, is associated with hypocalcemia, hypercalciuria, and increased bone mineral density (BMD). Conventional therapy with calcium and 1,25-dihydroxyvitamin D can maintain the serum calcium concentration, but doses are high, and control is variable. We investigated the effects of human PTH(1–84) treatment in hypoparathyroidism.

Methods

Thirty subjects with hypoparathyroidism were treated in an open-label study of PTH(1–84) 100 µg every other day by subcutaneous injection for 24 months, with monitoring of calcium and vitamin D supplementation requirements, serum and 24 h urinary calcium excretion, and BMD by dual energy X-ray absorptiometry.

Results

Requirements for supplemental calcium decreased significantly (3,030 ± 2,325 to 1,661 ± 1,267 mg/day (mean ± SD); p < 0.05), as did requirements for supplemental 1,25-dihydroxyvitamin D (0.68 ± 0.5 to 0.40 ± 0.5 µg/day; p < 0.05). Serum calcium levels and 24 h urinary calcium excretion were mostly unchanged at 24 months. BMD increased at the lumbar spine by 2.9 ± 4% from baseline (p < 0.05), while femoral neck BMD remained unchanged and distal one third radial BMD decreased by 2.4 ± 4% (p < 0.05).

Conclusion

PTH(1–84) treatment in hypoparathyroidism significantly reduces supplemental calcium and 1,25-dihydroxyvitamin D requirements without generally altering serum and urinary calcium levels.

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Funding

DK067619, DK 069350, FD-R-02525, and NPS Pharmaceuticals.

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Correspondence to M. R. Rubin.

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Rubin, M.R., Sliney, J., McMahon, D.J. et al. Therapy of hypoparathyroidism with intact parathyroid hormone. Osteoporos Int 21, 1927–1934 (2010). https://doi.org/10.1007/s00198-009-1149-x

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  • DOI: https://doi.org/10.1007/s00198-009-1149-x

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