Endocrine Abstracts

Background: Conventional treatment for chronic hypoparathyroidism (HypoPT) is activated vitamin D analogues and calcium supplementation. Recombinant parathormone (rhPTH 1-84, Natpar) provides physiological replacement and has demonstrated better biochemical control & QoL in REPLACE & BALANCE trials.

Aims: To assess the impact of Natpar on biochemical parameters and QoL in HypoPT.

Methods: Retrospective electronic records review of 128 consecutive Hypoparathyroid patients with at least 12-months treatment between 1987 & 2025, focusing on pre-/post Natpar arms, comparing conventional treatment (non-Natpar); audit No 9217.

Results: n = 128 (Natpar 5, Non-Natpar 123), mean age 53yrs, Mean duration of follow up 16.5yrs. n = 5 Natpar patients with mean follow-up 4.6yrs. Pre-Natpar Mean calcium 2.31 mmol/l (1.72–3.70); post-Natpar Mean Calcium 2.18 mmol/l (1.90–2.56). Mean eGFR improved from 77 to 92 mL/min. 1 hospital admission for hypocalcaemia; 1 patient had osteopenia (likely pre-existent); others had normal bone density. HPQ-28 scores (QoL questionnaire): pre-Natpar (24, 45, 15, 19) vs post-Natpar (8, 3, 2.5, 6.6), with the greatest gains in mood and energy. Patients describe Natpar as ‘a game changer’.

Discussion: 1. Natpar improves biochemical control, renal function and QoL in HypoPT, & is an option in patients inadequately controlled on conventional treatment. 2. Natpar is withdrawn from the market in December 2025 due to production issues; PTH analogues such as Palopegteriparatide & Eneboparatide bear similar beneficial outcomes & could potentially be considered as alternatives.