title: Parathyroid Hormone Replacement Therapy in Hypoparathyroidism: A Meta-Analysis.
abstract: This study investigated the effect of human parathyroid hormone replacement therapy on specific disease-related outcomes in patients with hypoparathyroidism. Medline, Cochrane, EMBASE, and Google Scholar databases were searched until January 13, 2015 for randomized trials using the following search terms: hypoparathyroidism, parathyroid hormone/PTH, and hormone replacement therapy. Five randomized controlled trials (n=245) that investigated effect of either PTH (1-34) (3 trials) or PTH (1-84) (2 trials) on serum calcium, phosphate, 1, 25-dihydroxyvitamin D, 25-dihydroxyvitamin D levels, and urine level of calcium were included in the meta-analysis. Both PTH (1-34) and PTH (1-84) therapies were not associated with change in serum calcium level compared with calcitriol/placebo. The level of 24-h urine calcium excretion had a significant decrease in PTH (1-34)-treated group compared placebo/calcitriol (control) group (p≤0.012). PTH (1-34) did not change serum phosphate (p=0.053). PTH (1-84) did not change level of 24-h urine calcium excretion compared with control (p≥0.214) but it did decrease the levels of serum phosphorous (p=0.000). Both PTH-replacement therapies were not associated with change in serum 1,25-dihydroxyvitamin D level compared with control (p≥0.606), but were associated with a significant decrease in serum 25-dihydroxyvitamin D levels (p≤0.04). In conclusion, although the number of randomized trial is limited, our meta-analysis suggests that PTH (1-34) replacement therapy may maintain the serum calcium levels in the normal range by reducing the levels of urine calcium excretion, and both replacement therapies may maintain 1,25-dihydroxyvitamin D serum levels by reducing serum level of 25-dihydroxyvitamin D.
authors.affiliation: Department of Endocrinology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: X-X
authors.initials: XX
authors.lastname: Liu
authors.affiliation: Department of Neurology, Shanghai First People's Hospital, Shanghai Jiao Tong University, Shanghai, China.
authors.forename: X-Y
authors.initials: XY
authors.lastname: Zhu
authors.affiliation: Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: G-H
authors.initials: GH
authors.lastname: Mei
mesh_terms: D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood / Q000652:urine; D005260:Female; D020249:Hormone Replacement Therapy; D006801:Humans; D007011:Hypoparathyroidism / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000627:therapeutic use*; D010710:Phosphates / Q000097:blood; D016896:Treatment Outcome; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood
chemical_list: D010281:Parathyroid Hormone; D010710:Phosphates; D014807:Vitamin D; C097949:1,25-dihydroxyvitamin D; C104450:25-hydroxyvitamin D; D002118:Calcium