Journal
JOURNAL OF BONE AND MINERAL RESEARCH
Volume 35, Issue 7, Pages 1274-1281Publisher
WILEY
DOI: 10.1002/jbmr.4005
Keywords
BONE MICROARCHITECTURE; HIGH-RESOLUTION PERIPHERAL QUANTITATIVE COMPUTED TOMOGRAPHY (HR-PQCT); HYPOPARATHYROIDISM
Categories
Funding
- NIH [DK069350, DK32333, DK095944]
- Shire Pharma
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Bone remodeling is reduced in hypoparathyroidism, resulting in increased areal bone mineral density (BMD) by dual-energy X-ray absorptiometry (DXA) and abnormal skeletal indices by transiliac bone biopsy. We have now studied skeletal microstructure by high-resolution peripheral quantitative computed tomography (HR-pQCT) through 4 years of treatment with recombinant human PTH(1-84) (rhPTH[1-84]) in 33 patients with hypoparathyroidism (19 with postsurgical disease, 14 idiopathic). We calculated Z-scores for our cohort compared with previously published normative values. We report results at baseline and 1, 2, and 4 years of continuous therapy with rhPTH(1-84). The majority of patients (62%) took rhPTH(1-84) 100 mu g every other day for the majority of the 4 years. At 48 months, areal bone density increased at the lumbar spine (+4.9% +/- 0.9%) and femoral neck (+2.4% +/- 0.9%), with declines at the total hip (-2.3% +/- 0.8%) and ultradistal radius (-2.1% +/- 0.7%) (p < 0.05 for all). By HR-pQCT, at the radius site, very similar to the ultradistal DXA site, total volumetric BMD declined from baseline but remained above normative values at 48 months (Z-score + 0.56). Cortical volumetric BMD was lower than normative controls at baseline at the radius and tibia (Z-scores -1.28 and - 1.69, respectively) and further declined at 48 months (-2.13 and - 2.56, respectively). Cortical porosity was higher than normative controls at baseline at the tibia (Z-score + 0.72) and increased through 48 months of therapy at both sites (Z-scores +1.80 and + 1.40, respectively). Failure load declined from baseline at both the radius and tibia, although remained higher than normative controls at 48 months (Z-scores +1.71 and + 1.17, respectively). This is the first report of noninvasive high-resolution imaging in a cohort of hypoparathyroid patients treated with any PTH therapy for this length of time. The results give insights into the effects of long-term rhPTH(1-84) in hypoparathyroidism. (c) 2020 American Society for Bone and Mineral Research.
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