Bone Abstracts (2016) 5 WSWS6.3 | DOI: 10.1530/boneabs.5.WS6.3

Management of hypoparathyroidism

Lars Rejnmark

Aarhus University Hospital, Aarhus, Denmark.

Recent studies have revealed hypoparathyroidism to be a disease associated with an increased risk of a number of co-morbidities including seizures, renal diseases, and infections as well as an impaired quality of life. In the summer of 2015, the first international guideline on treatment of hypoparathyroidism in the adults was published by the European Society of Endocrinology. The guideline is based on a systematic literature search for which available evidence was synthesized in order to assess: what is the best treatment for adult patients with chronic HypoPT? The Guideline suggest to treat patients with active vitamin D analogues (alfacalcidol or calcitriol) and calcium supplements in order to maintain serum calcium levels in the lower part or slightly below the lower limit of the reference range (target range) with patients being free of symptoms or signs of hypocalcaemia. Additional goals of treatment are to keep 24-h urinary calcium excretion within the sex-specific reference range, to avoid hyperphosphatemia, and to maintain the serum calcium–phosphate product below 4.4 mmol2/l2 (55 mg2/dl2). Patients should also have serum magnesium levels within the reference range and an adequate vitamin D status. The clinical importance of archiving these goals is, however, only poorly documented. Only sparse data exist on whether risk of complications is reduced in response to optimization of treatment. It is therefore of major importance that treatment is personalized with focus on the overall well-being and quality of life of patients. Aims to archive the biochemical targets should not impede the well-being of patients. In the future, replacement therapy with parathyroid hormone may become an alternative to conventional treatment as studies have suggested an improved QoL with a reduction in urinary calcium and serum phosphate level in response to PTH treatment.

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