Department of Medicine, Division of Endocrinology, College of Physicians and Surgeons, Columbia University, New York, New York.
Department of Medicine, Sengkang General Hospital, Singapore.
J Clin Endocrinol Metab. 2019 Nov 1;104(11):5601-5610. doi: 10.1210/jc.2019-00893.
Conventional treatment of hypoparathyroidism is associated with decreased renal function and increased bone mineral density (BMD).
To evaluate the effects of 8 years of recombinant human parathyroid hormone (1-84) [rhPTH(1-84)] therapy on key biochemical and densitometric indices.
Prospective open-label trial.
Tertiary medical center.
Twenty-four subjects with hypoparathyroidism.
Treatment with rhPTH(1-84) for 8 years.
Supplemental calcium and vitamin D requirements, serum calcium and phosphorus levels, calcium-phosphate product, urinary calcium excretion, estimated glomerular filtration rate (eGFR) and BMD.
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.
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.
甲状旁腺功能减退症的传统治疗与肾功能下降和骨密度（BMD）增加有关。
评估 8 年重组人甲状旁腺激素（1-84）[rhPTH（1-84）]治疗对关键生化和密度计指标的影响。
前瞻性开放标签试验。
三级医疗中心。
24 例甲状旁腺功能减退症患者。
rhPTH（1-84）治疗 8 年。
补充钙和维生素 D 的需求、血清钙和磷水平、钙磷乘积、尿钙排泄、估计肾小球滤过率（eGFR）和 BMD。
甲状旁腺激素治疗与 8 年内补充钙（57%；P < 0.01）和活性维生素 D（76%；P < 0.001）需求的逐渐减少有关。血清钙浓度稳定；尿钙排泄减少 38%（P < 0.01）。eGFR 保持稳定，与基线 eGFR 和血清钙水平相关。钙磷乘积低于推荐范围；血清磷仍在正常范围内。腰椎和全髋 BMD 增加，在第 4 年（平均 ± SE，4.6% ± 1.5%；P = 0.01）和第 8 年（2.6% ± 1.1%；P = 0.02）达到峰值，而股骨颈 BMD 没有变化，三分之一半径 BMD 减少（平均 ± SE，-3.5% ± 1.1%；P = 0.001）。在整个 8 年期间，所有部位的 BMD 均高于年龄和性别匹配的参考人群。高钙血症和低钙血症不常见。
rhPTH（1-84）是甲状旁腺功能减退症 8 年的安全有效治疗方法。补充需求的长期减少和肾功能稳定的生化改善得以维持。
