Hypoparathyroidism: clinical features, skeletal microstructure and parathyroid hormone replacement.
OBJECTIVE
Hypoparathyroidism is a disorder in which parathyroid hormone is deficient in the circulation due most often to immunological destruction of the parathyroids or to their surgical removal. The objective of this work was to define the abnormalities in skeletal microstructure as well as to establish the potential efficacy of PTH(1-84) replacement in this disorder.


METHODS
Standard histomorphometric and microCT analyses were performed on iliac crest bone biopsies obtained from patients with hypoparathyroidism. Participants were treated with PTH(1-84) for two years.


RESULTS
Bone density was increased and skeletal features reflected the low turnover state with greater BV/TV, Tb. Wi and Ct. Wi as well as suppressed MS and BFR/BS as compared to controls. With PTH(1-84), bone turnover and bone mineral density increased in the lumbar spine. Requirements for calcium and vitamin D fell while serum and urinary calcium concentrations did not change.


CONCLUSIONS
Abnormal microstructure of the skeleton in hypoparathyroidism reflects the absence of PTH. Replacement therapy with PTH has the potential to correct these abnormalities as well as to reduce the requirements for calcium and vitamin D.
Rubin
Mishaela R
MR
Departamento de Medicina, Columbia University, Nova York, Estados Unidos.
Bilezikian
John P
JP
D000368:Aged; D001706:Biopsy; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001842:Bone and Bones / Q000187:drug effects / Q000648:ultrastructure*; D002118:Calcium / Q000032:analysis / Q000627:therapeutic use*; D016022:Case-Control Studies; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D007011:Hypoparathyroidism / Q000188:drug therapy* / Q000473:pathology; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000627:therapeutic use*; D013131:Spine / Q000187:drug effects; D014807:Vitamin D / Q000032:analysis / Q000627:therapeutic use*; D055114:X-Ray Microtomography
D050071:Bone Density Conservation Agents; D010281:Parathyroid Hormone; D014807:Vitamin D; D002118:Calcium