Published in:The Journal of Clinical Endocrinology & Metabolism
Language:
English
DOI:
10.1210/jc.2019-00893
ISSN:
0021-972X;
1945-7197
Origination:
Footnote:
Description:
<jats:title>Abstract</jats:title>
<jats:sec>
<jats:title>Context</jats:title>
<jats:p>Conventional treatment of hypoparathyroidism is associated with decreased renal function and increased bone mineral density (BMD).</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Objective</jats:title>
<jats:p>To evaluate the effects of 8 years of recombinant human parathyroid hormone (1-84) [rhPTH(1-84)] therapy on key biochemical and densitometric indices.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Design</jats:title>
<jats:p>Prospective open-label trial.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Setting</jats:title>
<jats:p>Tertiary medical center.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Participants</jats:title>
<jats:p>Twenty-four subjects with hypoparathyroidism.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Intervention</jats:title>
<jats:p>Treatment with rhPTH(1-84) for 8 years.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Main Outcome Measures</jats:title>
<jats:p>Supplemental calcium and vitamin D requirements, serum calcium and phosphorus levels, calcium-phosphate product, urinary calcium excretion, estimated glomerular filtration rate (eGFR) and BMD.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Results</jats:title>
<jats:p>PTH therapy was associated with progressive reduction in supplemental calcium (57%; P < 0.01) and active vitamin D (76%; P < 0.001) requirements over 8 years. Serum calcium concentration was stable; urinary calcium excretion declined 38% (P < 0.01). eGFR remained stable and was related to baseline eGFR and serum calcium levels. Calcium-phosphate product was below the recommended limit; serum phosphorus remained within normal range. Lumbar spine and total hip BMD increased, peaking at 4 (mean ± SE, 4.6% ± 1.5%; P = 0.01) and 8 years (2.6% ± 1.1%; P = 0.02), whereas femoral neck BMD did not change and one-third radius BMD decreased (mean ± SE, −3.5% ± 1.1%; P = 0.001). BMD at all sites was higher throughout the 8 years than in the age- and sex-matched reference population. Hypercalcemia and hypocalcemia were uncommon.</jats:p>
</jats:sec>
<jats:sec>
<jats:title>Conclusion</jats:title>
<jats:p>rhPTH(1-84) is a safe and effective treatment for hypoparathyroidism for 8 years. Long-term reductions in supplemental requirements and biochemical improvements with stable renal function are maintained.</jats:p>
</jats:sec>