The Clinical and Skeletal Effects of Long‐Term Therapy of Hypoparathyroidism With rhPTH(1‐84)

• Published in: Journal of bone and mineral research 2023-04, Vol.38 (4), p.480-492
• Main Authors: Agarwal, Sanchita, McMahon, Donald J., Chen, Juliet, Brossfield, Aiden V., Fernando, Jason, Bilezikian, John P., Cusano, Natalie E., Rubin, Mishaela R.
• Format: Article
• Language: English
• Subjects: Absorptiometry, Photon; Bone and Bones; Bone Density; Bone mass; Bone mineral density; BONE QCT; Bone remodeling; Calcium; Calcium (blood); Calcium, Dietary; CLINICAL TRIALS; Computed tomography; Dietary supplements; Dual energy X-ray absorptiometry; Epidermal growth factor receptors; Glomerular filtration rate; HORMONE REPLACEMENT; Humans; Hypocalcemia; Hypoparathyroidism; Hypoparathyroidism - diagnostic imaging; Hypoparathyroidism - drug therapy; Parathyroid hormone; Parathyroid Hormone - pharmacology; Parathyroid Hormone - therapeutic use; PARATHYROID‐RELATED DISORDERS; Porosity; QUANTITATION OF BONE; Radius; Spine (lumbar); Tibia; Vitamin D
• ISSN: 0884-0431; 1523-4681
• DOI: 10.1002/jbmr.4780

ABSTRACT Hypoparathyroidism (HypoPT) is a disorder characterized by hypocalcemia, low or absent parathyroid hormone (PTH) levels, reduced bone remodeling, and high areal bone mineral density (aBMD). PTH is a therapeutic option, yet data on the prolonged clinical and skeletal effects of PTH treatment are limited. We tracked annual daily doses of calcium and active vitamin D supplements, calciotropic biochemistries, estimated glomerular filtration rate (eGFR), and aBMD measurements in 27 HypoPT patients (16 postsurgical, 11 nonsurgical) who were treated with recombinant human PTH(1‐84) [rhPTH(1‐84)] for at least 8 (n = 27) and up to 12 (n = 14) years. We also performed high‐resolution‐peripheral quantitative computed tomography (HRpQCT) imaging and report results at baseline, 5, 8, and 12 years of rhPTH(1‐84) treatment. With prolonged use of rhPTH, reductions in the need for supplemental calcium and active vitamin D were maintained. The eGFR did not decline. Serum calcium was maintained within the lower limit of the normal range. aBMD by dual‐energy X‐ray absorptiometry (DXA) showed an increase at the lumbar spine and a decrease at the distal 1/3 radius. By HRpQCT, cortical volumetric BMD (vBMD) at the tibia decreased at year 5: −20.0% ± 1.5%. The magnitude of this reduction was mitigated in year 8: −8.5% ± 1.6% and in year 12: −10.3% ± 2.2% but all were significantly below the mean baseline value (p