Hypoparathyroidism: Musculoskeletal Manifestations Related to Parathormone Deficiency.

Abstract

Hypoparathyroidism is a rare metabolic disorder characterized by a deficiency in the parathyroid hormone. This manuscript aims to provide an updated review of musculoskeletal diseases and conditions associated with adult-onset nonsurgical nongenetic hypoparathyroidism. Musculoskeletal manifestations are frequent in patients with hypoparathyroidism and can reveal this disease. They may include myopathy, shoulder disorder, immune-negative non-erosive peripheral arthritis, axial involvement simulating spondylarthritis, and diffuse ligamentous ossifications. An association between hypoparathyroidism and spondyloarthritis or autoimmune diseases is possible. T-cell activation can be seen in patients with hypoparathyroidism and may explain the co-occurrence of hypoparathyroidism with other autoimmune diseases. The treatment of these manifestations is based on conventional therapy with calcium and active vitamin D. Parathyroid hormone may have an anabolic effect on muscle atrophy and muscle weakness. Diffuse myalgia, muscle cramps, weakness, and myopathy can appear in patients with hypoparathyroidism. Besides, parathyroid hormone can promote bone formation and bone resorption by stimulating osteoclast differentiation by increasing RANKL (receptor activator for nuclear factor kappa- B ligand) expression. Therefore, hypoparathyroidism can be responsible for an increase in bone mineral density. The risk of fractures does not appear to be reduced due to changes in bone microarchitecture and the high risk of falls. Treatment with parathyroid hormone has been shown to improve bone microarchitecture.