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Calcium is not only the most abundant mineral in bone but also the most abundant mineral in the human body. Calcium ions are needed for bone mineralization, tooth health, heart rate regulation and strength of contraction, blood coagulation, the contraction of smooth and skeletal muscle cells, and the regulation of nerve impulse conduction. The average calcium level in the blood is about 10 mg/dL. When the body cannot maintain this level, a person will experience hypo or hypercalcemia.
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Hypoparathyroidism: Replacement Therapy with Parathyroid Hormone.

Lars Rejnmark1, Line Underbjerg2, Tanja Sikjaer2

  • 1Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark. rejnmark@clin.au.dk.

Endocrinology and Metabolism (Seoul, Korea)
|September 24, 2015
PubMed
Summary

Patients with hypoparathyroidism (HypoPT) experience poor quality of life despite calcium normalization. New parathyroid hormone (PTH) therapies show promise, but further research is needed to confirm benefits for quality of life and complication risks.

Keywords:
CalciumHypoparathyroidismParathyroid hormone treatmentVitamin D

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Area of Science:

  • Endocrinology
  • Metabolic Bone Disease

Background:

  • Hypoparathyroidism (HypoPT) involves insufficient parathyroid hormone (PTH) secretion, leading to low serum calcium.
  • Conventional treatment with vitamin D analogues and calcium normalizes serum calcium but not calcium-phosphate homeostasis, resulting in impaired quality of life (QoL) and comorbidities.

Purpose of the Study:

  • To evaluate the efficacy and potential of parathyroid hormone (PTH) replacement therapies in managing hypoparathyroidism (HypoPT).
  • To assess if novel PTH therapies can improve patient QoL and reduce complication risks compared to conventional treatments.

Main Methods:

  • Review of recent studies investigating recombinant human PTH (rhPTH(1-84)) and rhPTH(1-34) therapies.
  • Analysis of outcomes related to serum calcium levels, need for supplements, and injection frequency.
  • Exploration of emerging pump-delivery systems for PTH replacement.

Main Results:

  • Both rhPTH(1-84) and rhPTH(1-34) normalize serum calcium and reduce reliance on vitamin D and calcium supplements.
  • Once-daily PTH injections cause significant calcium fluctuations; twice-daily injections reduce fluctuations but do not restore physiological homeostasis.
  • Pump-delivery systems show promise in maintaining normocalcemia with minimal fluctuations.

Conclusions:

  • While PTH replacement therapies normalize calcium levels, current injection methods present challenges in achieving physiological calcium-phosphate balance.
  • Pump-delivery systems offer a potential advancement for PTH replacement therapy, warranting further investigation.
  • Additional research is required to confirm improvements in QoL and reduced complication risks before PTH replacement can be recommended as standard HypoPT therapy.