Risk of bone overstimulation in long-term PTH(1-34) therapy for hypoparathyroidism
Authors' conclusion
Long-term PTH(1-34) therapy in chronic hypoparathyroidism is frequently associated with excessive bone remodeling despite adequate calcemic control. Careful monitoring is therefore essential, especially in patients with elevated bone remodeling markers and hypomagnesemia.
Study context
- Population
- Adults with chronic hypoparathyroidism treated with PTH(1–34) for >2 years; median age 44 years, 75.6% women
- Participants
- 41 adults
- Outcome
- Proportion of patients with pathological increases in bone tracer uptake on whole-body 99mTc-methylenediphosphonate scintigraphy
Methodological detailsmulticentre (3 referral centers), Mean daily PTH(1-34) dose 29.9 µg [Q1; Q3 22.5; 39.9] for 57 months [40; 70]; exposure 218.3 patient-years
- Multicentre (3 referral centers)
- Mean daily PTH(1-34) dose 29.9 µg [Q1; Q3 22.5; 39.9] for 57 months [40; 70]; exposure 218.3 patient-years
Main finding
As reported in the abstract
Pathological bone uptake
Patients with pathological bone uptake, despite serum calcium predominantly in target range
25
61%
Observational data: associations, not effects.
Further findings
| Outcome | P value |
|---|---|
| Weight-adjusted PTH(1-34) dose, patients with vs without pathological uptake | P = 0.045 |
- Weight-adjusted PTH(1-34) dose, patients with vs without pathological uptake: 0.44 µg/kg [0.32; 0.56] vs 0.34 µg/kg [0.24;0.40]; higher with pathological uptake
Weight-adjusted PTH(1-34) dose, patients with vs without pathological uptake
- Affected patients also had elevated bone remodeling markers, lower serum magnesium and increased urinary calcium excretion
- Osteoarticular pain did not differentiate affected individuals
Score combining serum CTX, osteocalcin and magnesium: correct classification
- Patients correctly classified
- 97% (95% CI: 91%-100%)
Original publication
Risk of bone overstimulation in long-term PTH(1-34) therapy for hypoparathyroidism. Eur J Endocrinol. Published 15 April 2026. doi:10.
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