The role of palopegteriparatide in the treatment of hypoparathyroidism
Authors:
Králik Roman; Pavúková Simona; Payer Juraj; Kužma Martin
Authors‘ workplace:
V. interná klinika LF UK a UNB, Bratislava
Published in:
Clinical Osteology 2025; 30(1): 42-45
Category:
Overview
Hypoparathyroidism is a rare endocrine disorder characterized by insufficient secretion of parathyroid hormone, leading to hypocalcemia and its severe clinical consequences. While there are various etiological forms, the most common cause is post-surgical removal of the parathyroid glands, such as after total thyroidectomy. Diagnosis is based on low parathyroid hormone levels combined with hypocalcemia and other biochemical changes. Clinical manifestations range from mild neurological symptoms to life-threatening complications such as laryngospasms and cardiac arrhythmias. Long-term complications include nephrolithiasis, renal insufficiency, and alterations in bone remodeling. The standard treatment consists of active vitamin D and oral calcium supplementation; however, this therapy does not always adequately regulate calcium metabolism without the risk of hypercalciuria and nephropathy. Newly developed treatment options, such as palopegteriparatide (TransCon PTH), represent a potential breakthrough in hypoparathyroidism management. This innovative form of parathyroid hormone has a prolonged effect, enabling calcium stabilization while minimizing the need for calcium and vitamin D supplementation. Clinical studies demonstrate significant improvements in patients’ quality of life and a reduction in complication rates. Although palopegteriparatide shows high efficacy and a favorable safety profile, its availability in Slovakia and Czechia remains limited. Its approval and inclusion in therapeutic options could significantly change the approach to hypoparathyroidism treatment and improve patient outcomes.
Keywords:
hypoparathyroidism, standard therapy, complications, palopegteriparatide.
Sources
1. Karpf D, et al. Prevalence of hypoparathyroidism in the EU: a systematic review and meta-analysis. Endocrine abstracts. 2020.
2. Siraj N, Hakami Y, Khan A. Medical hypoparathyroidism. Endocrinol Metab Clin North Am. 2018;47(4):797-808.
3. Hannan FM, Babinsky VN, Thakker RV. Disorders of the calcium-sensing receptor and partner proteins: insights into the molecular basis of calcium homeostasis. J Mol Endocrinol. 2016;57(3):R127-R142.
4. El-Hattab AW, Adesina AM, Jones J, Scaglia F. MELAS syndrome: clinical manifestations, pathogenesis, and treatment options. Mol Genet Metab. 2015;116(1-2):4-12.
5. Abraham MB, Li D, Tang D, et al. Short-stature and hypoparathyroidism in a child with Kenny-Caffey syndrome type 2 due to a novel mutation in FAM111A gene. Int J Pediatr Endocrinol. 2017;2017:1.
6. Silva BC. Skeletal and nonskeletal consequences of hypoparathyroidism. Arch Endocrinol Metab 2022. doi: 10.20945/2359-3997000000553.
7. Vadiveloo T, Donnan PT, Leese CJ, Abraham KJ, Leese GP. Increased mortality and morbidity in patients with chronic hypoparathyroidism: a population-based study. Clin Endocrinol. 2019;90:285-292.
8. Cusano NE, Bilezikian JP. Signs and Symptoms of Hypoparathyroidism. Endocrinol Metab Clin North Am. 2018;47(4):759-770.
9. Saini N, Mishra S, Banerjee S, Rajput R. Hypocalcemic cardiomyopathy: a rare presenting manifestation of hypoparathyroidism. BMJ Case Rep. 2019;12.
10. Brod M, Waldman LT, Smith A, Karpf D. Assessing the Patient Experience of Hypoparathyroidism Symptoms: Development of the Hypoparathyroidism Patient Experience Scale-Symptom (HPES-Symptom) Patient. 2020.
11. Brod M, Waldman LT, Smith A, Karpf D. Living with hypoparathyroidism: development of the Hypoparathyroidism Patient Experience Scale-Impact (HPES-Impact) Qual Life Res. 2021.
12. Hadker N, Egan J, Sanders J, et al. Understanding the burden of illness associated with hypoparathyroidism reported among patients in the PARADOX study. Endocr Pract.2014;20(7):671-679.
13. Meola A, Vignali E, Matrone A, Cetani F, Marcocci C. Efficacy and safety of long-term management of patients with chronic post-surgical hypoparathyroidism. J Endocrinol Investig. 2018;41(10):1221-1226.
14. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study. J Bone Miner Res. 2013;28(11):2277-2285.
15. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. The epidemiology of nonsurgical hypoparathyroidism in Denmark: a nationwide case finding study. J Bone Miner Res. 2015;30(9):1738-1744.
16. Silva BC. Skeletal and nonskeletal consequences of hypoparathyroidism. Arch Endocrinol Metab. 2022. doi: 10.20945/2359-3997000000553.
17. Rubin MR. Skeletal Manifestations of Hypoparathyroidism. Bone 2019;120:548-555.
18. Cipriani C, Minisola S, Bilezikian JP, Diacinti D, Colangelo L, Piazzolla V, et al. Vertebral Fracture Assessment in Postmenopausal Women With Postsurgical Hypoparathyroidism. J Clin Endocrinol Metab. 2021;106(5):1303-1311.
19. Kršek M, et al. Doporučený postup české endokrinologické společnosti pro diagnostiku a léčbu primární hyperparatyreózy a hypoparatyreózy. Vnitř Lék. 2021;67(Suppl. A).
20. Lazúrová I, Payer J, et al. Štandardné diagnostické a terapeutické postupy v endokrinológii. II. vyd. Vienala: Košice 2014. ISBN: 978-80-8126-089-6.
21. Khan AA, et al. Efficacy and Safety of Parathyroid Hormone Replacement With TransCon PTH in Hypoparathyroidism: 26-Week Results From the Phase 3 PaTHway Trial. J Bone Miner Res. 2023 Jan;38(1):14-25. doi: 10.1002/jbmr.4726. Epub 2022 Nov 12. PMID: 36271471; PMCID: PMC10099823.
22. Khan AA, et al. PaTH Forward: A Randomized, Double-Blind, Placebo-Controlled Phase 2 Trial of TransCon PTH in Adult Hypoparathyroidism. J Clin Endocrinol Metab. 2022 Jan 1;107(1):e372-e385. doi: 10.1210/clinem/dgab577. PMID: 34347093; PMCID: PMC8684498.
23. Clarke BL, et al. Efficacy and Safety of TransCon PTH in Adults with Hypoparathyroidism: 52-Week Results From the Phase 3 PaTHway Trial. J Clin Endocrinol Metab. 2024 Oct 8; dgae693. doi: 10.1210/clinem/dgae693. Epub ahead of print. Erratum in: J Clin Endocrinol Metab. 2025 Feb 04:dgaf048. doi: 10.1210/clinem/dgaf048. PMID: 39376010.
Labels
Clinical biochemistry Paediatric gynaecology Paediatric radiology Paediatric rheumatology Endocrinology Gynaecology and obstetrics Internal medicine Orthopaedics General practitioner for adults Radiodiagnostics Rehabilitation Rheumatology Traumatology OsteologyArticle was published in
Clinical Osteology
2025 Issue 1
Most read in this issue
- From despair to results: Clinical experience and effective strategies in the treatment of calciphylaxis
- Vitamin D – current overview of the issue and specifics in nephrological practice
- A completely now approach to the issue of bone disease in patients with chronic kidney disease – what KDIGO practice recommendations can we expect? Commentary on the KDIGO 2025 Controversies Conference.
- Několik slov úvodem