Teriparatide Therapy in Children with Hypoparathyroidism: A Systematic Review and Meta-Analysis

Hypoparathyroidism in children is conventionally treated with calcium and active vitamin D, however, this approach does not restore parathyroid hormone (PTH) action and may leave hyperphosphatemia unresolved while increasing the risk of hypercalciuria. Teriparatide (PTH 1-34) offers a physiologic replacement, although evidence regarding its role in children remains limited. We systematically reviewed biochemical and skeletal effects of teriparatide in children with hypoparathyroidism. MEDLINE and Embase were searched from inception to January 2026, including studies of patients ≤ 21 years treated with teriparatide for ≥ 4 weeks. Outcomes included calcium and phosphate homeostasis, skeletal outcomes, growth, renal complications, and use of concomitant therapy. Data extraction followed Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines by 2 independent reviewers. Meta-analysis using weighted mean differences (WMDs) was performed when feasible. Other outcomes were summarized descriptively. Eighteen studies met the eligibility criteria, and a total of 94 pediatric patients were included. Serum calcium was maintained within target range with teriparatide, with no significant difference compared with conventional therapy (WMD -0.02, 95% CI -0.10 to 0.07). Serum phosphate was lower with teriparatide (WMD -0.28, 95% CI -0.45 to -0.12). Urinary calcium excretion findings were variable, although longer-term studies suggested reductions. Growth and bone mineral density remained within normal ranges. Renal outcomes were heterogeneous. Overall teriparatide maintains serum calcium and may improve phosphate balance in children with hypoparathyroidism. However, given limited and heterogeneous evidence, conventional therapy should remain first-line, with teriparatide considered in selected patients.