Is calcium supplementation always needed in patients with hypoparathyroidism?

Al-Sharefi, Ahmed; Glenister, Elizabeth; Morris, Margaret; Quinton, Richard

doi:10.1111/cen.13955

Cited by 10 publications

(7 citation statements)

References 16 publications

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“…In our group of patients, all had a rather high calcium intake with only little variability between patients, making it difficult to detect differences in a relative small sample size. A recent study from United Kingdom showed that patients with chronic HypoPT sometimes can be well managed by active vitamin D alone without any calcium supplements and that relief from using (high doses of) calcium supplements is preferred by the patients 18 . Accordingly, we do not believe that our findings should be interpreted in such a manner that calcium intake is not important.…”

Section: Discussionmentioning

confidence: 69%

“…A recent study from United Kingdom showed that patients with chronic HypoPT sometimes can be well managed by active vitamin D alone without any calcium supplements and that relief from using (high doses of) calcium supplements is preferred by the patients. 18 Accordingly, we do not believe that our findings should be interpreted in such a manner that calcium intake is not important. Larger studies including patients with a more diverse intake should be performed in order to test this hypothesis.…”

Section: F I G U R Ementioning

confidence: 76%

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Determinants of hypercalciuria and renal calcifications in chronic hypoparathyroidism: A cross‐sectional study

Ridder

Harsløf

Sikjær

et al. 2021

Clinical Endocrinology

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Hypoparathyroidism (HypoPT) is a rare endocrine disease, which causes hypocalcaemia due to missing or inappropriately low plasma levels of parathyroid hormone (P-PTH). 1 In most instances, the disease emerges following neck surgery, which causes damage to the parathyroid glands. However, in approximately one-fourth of the patients, the disease is due to non-surgical causes, including genetic variants and autoimmunity. 2 Due to lack of PTH, the renal 1α-hydroxylase (CYP27B1) is not well-stimulated resulting in a reduced synthesis of

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Section: Discussionmentioning

confidence: 69%

Section: F I G U R Ementioning

confidence: 76%

Determinants of hypercalciuria and renal calcifications in chronic hypoparathyroidism: A cross‐sectional study

Ridder

Harsløf

Sikjær

et al. 2021

Clinical Endocrinology

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“…obstipation, fl atulence and others), risk for vascular calcifi cations and renal stones [17][18][19]. Diff erent strategies have been implemented by other authors to overcome these worries -alternate calcium intake or even "no calcium" regimens [20,21]. The most common worries about calcitriol are kidney damage and polyuria as already reported in a diff erent study with 64 patients [20].…”

Section: Discussionmentioning

confidence: 99%

Biochemical Control of 78 Patients with Chronic Hypoparathyroidism Referred between 2006 and 2020 – Where do We Actually Stand?

Boyanov

Zamfirova

Bakalov

et al. 2023

Acta Medica Bulgarica

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Hypoparathyroidism (hypoPT) is a relatively rare endocrine disease, mainly due to thyroid surgery. The classical supplementation with calcium and active vitamin D may represent a challenge to the clinician. Objective To describe the level of biochemical control in patients with chronic hypoPT and to look for differences between postsurgical and non-surgical cases referred between 2006 and 2020. Materials and Methods This was a retrospective cross-sectional study with data review from the database of a tertiary endocrine clinic from the last 15 years. Cases with hypocalcemia not related to PTH were excluded. The patients’ medical history was reviewed as well as concomitant diseases and medications. Serum calcium (total, albumin-corrected and ionized; sCa, corrCa, iCa+) and phosphates (P), magnesium, creatinine, alkaline phosphatase together with 24hr urinary calcium and phosphate were measured. The intact parathyroid hormone (iPTH) was determined by electro-hemi-luminescence (Elecsys, Roche Diagnostics). Thyroid and abdominal ultrasound (US) were both performed. Results Seventy-eight patients met the study criteria – 69 were females. Most of them were between 30 and 60 years (mean age 50.6 ± 14.5 years). Albumin-corrected calcium was in target in 20.5% of the patients, ionized calcium – in 36.5%, serum phosphate – in 46.3%, serum magnesium – in 87.9%. When all four parameters were taken together, less than 20% were in target. Hypercalciuria was registered in 11.8%, while 57.1% of the patients had nephrolithiasis and 27.3% had CKD grade 3-4. Thus, a high proportion of patients with kidney involvement was identified. Calcium carbonate and calcitriol were the preferred replacement choices. Comparing patients with post-surgical and non-surgical hypoPT significant differences were found only for age, total serum calcium, serum magnesium and TSH. Conclusion Our study is the first of its kind in our country during the last two decades describing the contemporary clinical and biochemical picture of chronic hypoPT in patients referred for specialized care. Low supplementation doses leading to hypocalcemia and hyperphosphatemia were a common finding. Low patient’s adherence may be just one possible explanation. Non-surgical cases tend to have even lower calcium and magnesium levels. The patients, their families and treating physicians should be better informed about up-to-date management of chronic hypoPT and the possible impact of suboptimal treatment on morbidity and mortality of the affected subjects.

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“…( 12 Another potentially contentious point is that the Bollerslev guideline mandates the use of oral calcium salts but a growing body of evidence conflicts with this view suggesting that oral calcium salts are not necessarily routine and are only recommended for patients with a dietary calcium deficiency. 14 Finally, the methodology necessarily includes an element of "self assessment" and this too may have the potential to skew the data.…”

Section: Discussionmentioning

confidence: 99%

UK national chronic hypoparathyroidism audit

Kiam

Sharma

Glenister³

et al. 2022

Clinical Endocrinology

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Objectives Individuals with chronic hypoparathyroidism may experience suboptimal medical care with high frequency of unplanned hospitalisation and iatrogenic harm. In 2015 the European Society for Endocrinology published consensus guidelines on the management of chronic hypoparathyroidism. We set out to audit compliance with these guidelines. Methods Using these recommendations as audit standards we worked with the Society for Endocrinology and Parathyroid UK to conduct a national audit of management of chronic hypoparathyroidism in the United Kingdom. Endocrine leads in 117 endocrine departments were invited to participate in the survey by completing a data collection tool on up to 5 sequential cases of chronic hypoparathyroidism seen in their outpatient clinics in the preceding 12 months. Data were collected on 4 treatment standards and 9 monitoring standards. Data on hospitalisations and Quality of Life monitoring were also collected. Results Responses were received from 22 departments giving a response rate of 19%, concerning 80 individual cases. The mean age of subjects was 48.4 years. The main findings were that the commonest cause of hypoparathyroidism was post surgical (66.3%). Treatments taken by the group included activated vitamin D analogues (96.3%), oral calcium salts (66.3%), vitamin D supplements (17.5%), thiazide diuretics (5%) and rhPTH1–34 (1.3%). Compliance with the audit standards varied between 98.8% and 60% for the treatment standards and between 91.3% and 20% for the monitoring standards. Some of the areas of weakness revealed include low rates of 24 h urinary calcium excretion monitoring, serum magnesium monitoring and low rates of renal imaging where indicated. In addition and importantly, 16.3% of subjects had experienced at least one hospital admission in the preceding 12 months. Conclusion We conclude that further improvements in the UK national standard of management of chronic hypoparathyroidism should be made and that this will benefit both quality of life, morbidity and potentially mortality in this group of patients.

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Is calcium supplementation always needed in patients with hypoparathyroidism?

Cited by 10 publications

References 16 publications

Determinants of hypercalciuria and renal calcifications in chronic hypoparathyroidism: A cross‐sectional study

Determinants of hypercalciuria and renal calcifications in chronic hypoparathyroidism: A cross‐sectional study

Biochemical Control of 78 Patients with Chronic Hypoparathyroidism Referred between 2006 and 2020 – Where do We Actually Stand?

UK national chronic hypoparathyroidism audit

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