Hypoparathyroidism and treatment with recombinant human PTH

Introduction: Hypoparathyroidism is a rare endocrine disease, most frequently due to surgical damage to the parathyroids. Hypocalcemia, caused by this disease, can affect the function of most organs, but in particular neurological, cognitive, muscular, and cardiac functions. The long term consequences of hypoparathyroidism can include ectopic calcifications, renal complications and impaired quality of life. At last, in hypoparathyroidism higher bone mineral density and lower bone turnover markers are described, and these factors could have an impact on the risk of fracture, but still it is unclear. Areas covered: This disease is usually treated with calcium, calcitriol, or an active vitamin D analog. Although the standard therapy can adequately control patients, sometimes very high doses are required to maintain serum calcium levels in the normal range, with poor compliance and risk of long term complications. This article analyzes the recent therapeutic approach with the use of recombinant human PTH (rhPTH), through a systematic review of English articles regarding the use of rhPTH (1-84) and (1-34). Expert opinion: The possibility of having a therapeutic alternative, such as the rhPTH could represent a great opportunity. However, further studies are necessary to clarify several aspects especially regarding long term effects of rhPTH.