Hypertensive rodents often exhibit bone loss and osteopenia with impaired bone formation. We hypothesized that spontaneously hypertensive rats (SHR) could compensate for osteopathy through certain mechanisms, particularly intestinal calcium absorption. However, this calcium transport may be suppressed after long-term exposure to high luminal calcium levels during calcium supplementation through a molecular mechanism known as calcium-dependent inactivation of calcium channels. Herein, we designed calcium-rich formulations-that is, 14 mM CaCl2 + 12 mM l-Proline +20 µM sodium zinc chlorophyllin (CaA) and 14 mM CaCl2 + 12 mM l-Proline +60 µM sodium zinc chlorophyllin (CaB), with a total elemental calcium amount of < 16 mg/kg/day-administered orally to SHR and wild-type rats (WT), aiming to avoid suppressing the calcium transport rate. We found that SHR had greater systolic, diastolic, and mean arterial pressures than WT, while both CaA and CaB did not alter these parameters. Using an Ussing chamber with 45Ca radioactive tracer, both regimens did not affect the enhanced transepithelial calcium transport in the duodenum of SHR, although they increased epithelial potential difference and short-circuit current, indicators of electrogenic ion fluxes. Meanwhile, they did not alter mRNA expression levels of calcium transporters or tight junction components in the mucosal cells. In conclusion, unlike the known suppressive effects of certain calcium compounds on calcium absorption, oral administration using CaA and CaB formulations maintained high transport rates in SHR. This finding helps provide a basis for further clinical investigation into the optimization of calcium supplementation, particularly in the context of hypertension and osteoporosis.

Hypocalcemia has been recognized as a contributor to trauma-related mortality, yet optimal dosing of calcium during massive transfusion remains undefined. The literature suggests that ≥1g of calcium per 2 to 4 units of blood may correct hypocalcemia, but its effect on survival is unclear. This study evaluated the association between varying calcium:low-titer O whole blood (LTOWB) ratios and 24-hour mortality to define clinically meaningful supplementation targets. We performed a retrospective single-center cohort study of all trauma patients receiving LTOWB and calcium, prehospital, or within 4 hours of arrival (2020-2023). Demographics, mechanism of injury, Injury Severity Score (ISS), transfusion volume, and calcium administration were collected. Calcium supplementation was defined as a continuous variable (grams/unit), mutually exclusive ranges, and threshold doses of ≥1g per 2, 3, or 4 units of LTOWB. The primary outcome was 24-hour mortality. Multivariable logistic regression adjusted for confounders and calcium supplementation strategy. Of 542 LTOWB recipients, 99 undergoing CPR were excluded; 164 received no calcium, and 273 had complete datasets for analysis. Median age was 36 (25-50) years, 72% were male, median ISS was 19 [10-28], and 55% sustained blunt trauma. Median arrival ionized calcium was 1.02 (0.79-1.14) mEq/L. Twenty-four-hour mortality was 13.6% (n=37). On multivariable analysis, ≥1g calcium chloride per 2 units of LTOWB independently reduced the odds of 24-hour mortality by 84% [odds ratio, 0.164 (0.034-0.796), p =0.025]. Calcium chloride at this threshold neared significance for reduction in mortality ( p =0.06, adjusted OR=0.221 (0.045-1.077)] when restricting the analysis to patients receiving ≥2 units of LTOWB, while gluconate had no significant associations in this cohort with greater need for LTOWB resuscitation. In trauma patients receiving LTOWB, calcium chloride administered at ≥1g per 2 units showed a consistent association with improved early survival. A ≥1:2 calcium chloride-to-LTOWB dosing protocol may be an effective and clinically relevant target for trauma resuscitation. Prospective validation is warranted. ( J Trauma Acute Care Surg. 2026;101: 57-64. Copyright © 2026 Wolters Kluwer Health, Inc. All rights reserved.). Retrospective cohort study; Level III.

Limestone calcined clay cement (LC 3 ) with 50% clinker content represents a significant advancement in low-carbon binders but further clinker reduction is limited by insufficient portlandite (CH) availability to sustain pozzolanic reactions. Commercial CH addition defeats the low-carbon purpose due to its carbon emission higher than clinker. This study addresses this dual challenge by valorizing industrial carbide slag (CS), a CH-rich (80%) waste by-product – as a circular calcium source to enable low-clinker LC 3 formulations with 30% and 40% clinker factors. Six paste mixes were systematically evaluated, comparing raw CS and calcined CS against conventional LC 3 -50 and OPC controls. A multi-technique characterization framework was employed to establish the hydration kinetics, phase assemblage, C-(A)-S-H gel chemistry, and pore structure evolution. The results reveal a synergistic trade-off mechanism: although the addition of both CS forms inhibits the hydration of clinker silicates (C 3 S/C 2 S), this inhibition is effectively compensated by sustained pozzolanic reactions driven by the supplemental calcium and the formation of Al rich C–(A)–S–H gel with shorter silicate chains, alongside stable carboaluminate phases. Consequently, LC 3 -40-CaO achieves a 28-day compressive strength of 52.5 MPa, equivalent to LC 3 -50, while utilizing 10% less clinker. All CS-modified pastes exhibit refined pore structures (critical pore entry radii of 14–17 nm), comparable to LC 3 -50 (11 nm) and substantially finer than OPC (77 nm). Environmental performance indicators demonstrated 16% reduction in embodied CO 2 per MPa compared to LC 3 -50. This work establishes waste carbide slag as a viable, low-carbon CH source enabling mechanically robust LC 3 binders with clinker factors below 50%, advancing circular economy principles in sustainable cement production. • Multi-scale mechanistic framework explains dual calcium source pathways • Waste carbide slag enables <50% clinker content in LC 3 • Calcined carbide slag outperforms raw slag in the mechanical performance • 15-20% embodied CO 2 reduction versus LC 3 -50 through combined clinker reduction and waste valorization

Denosumab is increasingly used to treat osteoporosis in patients with advanced kidney disease, but clinically significant disturbances in calcium homeostasis remain a major concern. We report a peritoneal dialysis (PD) case in which denosumab administration was followed by pronounced calcium fluctuations requiring medication management. A 56-year-old woman with end-stage kidney disease due to lupus nephritis, receiving prednisolone (5mg/day), had been on continuous ambulatory PD (1.5-L exchanges three times daily) for 5years. Baseline intact parathyroid hormone was 176pg/mL. Osteoporosis was confirmed by dual-energy X-ray absorptiometry (lumbar spine 68% and femoral neck 58% of the young adult mean [YAM]). Denosumab 60mg was administered, and BMD increased within 10months to 78% YAM at the lumbar spine and 77% YAM at the femoral neck (same facility, identical DXA equipment). To mitigate hypocalcemia, dialysate calcium was pre-emptively increased to two 3.5-mEq/L and one 2.5-mEq/L bags per day (albumin-corrected calcium 9.5mg/dL at dosing). Nonetheless, symptomatic hypocalcemia developed (nadir 7.8mg/dL on day 7), prompting escalation to three 3.5-mEq/L bags with intensified vitamin D therapy and calcium supplementation. Serum calcium then overshot, peaking at 13.8mg/dL on day 29; therapy was de-escalated and calcium stabilized. This case highlights that while daily dialysate calcium exposure in PD may buffer early hypocalcemia, concurrent escalation of dialysate calcium, vitamin D therapy, and calcium supplementation can precipitate overshoot hypercalcemia. Frequent monitoring and staged, stepwise prescription changes during the first month after denosumab are essential. Standardized PD-specific post-denosumab calcium management protocols are urgently needed.

Broodmares are at increased risk of gastrointestinal colic. However, colic risk factors specific to this population have not been investigated. To investigate horse- and management-level risk factors for post-partum colic in a cohort of Thoroughbred broodmares in the United Kingdom and Ireland. Prospective, nested case-control study. Twenty-nine Thoroughbred stud farms in the United Kingdom and Ireland were recruited, and 1044 mares were followed over the 2021 and/or 2022 foaling seasons. Data were collected on signalment, medical and management history for post-partum colic mares and matched (3:1) controls. Multivariable analysis was conducted using conditional logistic regression. Due to strong collinearity between days post-partum and time spent stabled, two multivariable models were built. Days post-partum (Model 1: OR 0.9, 95% CI 0.8-0.9; p < 0.001) and increasing hours stabled (Model 2: OR 1.2, 95% CI 1.1-1.3; p < 0.001) were strongly associated with increased risk of post-partum colic. Colic risk was highest immediately post-partum, with reduction in likelihood of colic up to 50 days after foaling. NSAID use in the previous 28 days (Model 1: OR 6.2, 95% CI 2.0-65.5; Model 2: OR 4.1, 95% CI 1.1-15.0; p = 0.048) and a history of previous colic (Model 1: OR 7.4, 95% CI 1.2-7.9; Model 2: OR 5.3, 95% CI 1.7-17.1; p = 0.01) were also associated with increased colic risk. Calcium supplementation was associated with increased likelihood of post-partum colic in Model 1 only (OR 4.4, 95% CI 1.3-15.7; p = 0.04). Mares comprised a small sub-population of UK and Irish Thoroughbred broodmares. Pre-partum colic was not investigated. Maximising turnout in post-partum broodmares may reduce colic risk, immediately post-partum and up to 50 days. Broodmares who have recently received NSAIDs, have a history of colic or are receiving a calcium-based supplement may be at increased risk of post-partum colic.

Thyroidectomy is a fundamental therapeutic intervention for various thyroid disorders, yet it entails significant risks, including iatrogenic hypoparathyroidism. Since 2019, our institution has implemented a standardized post-thyroidectomy protocol using parathyroid hormone (PTH) and calcium measurements to stratify hypocalcemia risk and guide calcium and alfacalcidol supplementation. This study aimed to assess the effectiveness of this structured approach in reducing unscheduled referrals due to hypocalcemia within three weeks after total thyroidectomy and evaluate the utility of early postoperative PTH levels in predicting permanent hypoparathyroidism (PhP). A retrospective observational cohort study was conducted at Radboud UMC Nijmegen, including 373 adult patients who underwent total/completion thyroidectomy between January 2014 and April 2025. Patients were assigned to either the post-protocol cohort (PPC) (N = 154) or the historic cohort (N = 219), depending on whether surgery occurred after or before protocol implementation, and subsequently compared. Unscheduled referrals were significantly more frequent in the historic cohort than in the PPC (19.2% vs. 11% respectively, p = 0.034), and the introduction of the protocol was associated with a significant reduction in the odds of these referrals. Early postoperative PTH levels were a significant predictor of unscheduled referrals (p = 0.003), postoperative hypocalcemia (p < 0.001) and PhP (p < 0.001). A postoperative PTH cutoff of 1.7 pmol/L was identified as a clinically meaningful threshold for PhP prediction, demonstrating 100% sensitivity. Subject to assay availability and workflow efficiency, implementation of this protocol may reduce post-thyroidectomy emergency consultations and readmissions, improving healthcare resource utilization and optimizing follow-up.

Hypertensive disorders of pregnancy remain a major cause of maternal and perinatal morbidity and mortality worldwide. Calcium supplementation during pregnancy is recommended by guidelines and the World Health Organization to prevent preeclampsia largely based on successive versions of a Cochrane systematic review (SR). However, the 2025 update of this SR reported that calcium supplementation may result in little to no reduction in preeclampsia risk, a conclusion that diverges from all previous versions. This change was driven primarily by the exclusion from meta-analyses of several previously included trials due to concerns about study trustworthiness. We critically examine trustworthiness assessments in the 2025 SR and identify inconsistencies in how criteria were interpreted and applied across trials. Using two trials as illustrative examples, we show that concerns related to ethics and effect size were applied inconsistently. We further demonstrate that the same trials were deemed trustworthy and included in another Cochrane SR updated in 2024, on calcium supplementation during pregnancy for related outcomes. Sensitivity analyses illustrate how the inclusion of these two excluded trials would significantly change the pooled effect estimates for preeclampsia in the 2025 SR. We argue that reliance on unvalidated trial trustworthiness assessment tools risks subjective exclusion of evidence, potentially impacting guidelines and policies. We recommend that the review authors reassess all trials excluded from the meta-analyses due to trustworthiness issues and conduct sensitivity analyses to transparently assess their impact on the 2025 SR conclusions and related policy recommendations.

Senior osteoporosis (SOP) represents a significant health concern that impacts quality of life among the elderly population. Calcium supplementation is the most common treatment for those diagnosed with osteoporosis. However, the administration of inorganic calcium supplements is often associated with adverse effects, including constipation and nephrolithiasis. The fruit of Rosa roxburghii, commonly known as 'Ci Li' in Chinese, is both a medicine and a food. It aids in digestion, strengthens the spleen and stomach, and improves intestinal inflammation. The polysaccharides from R. roxburghii (RRFP) also exhibit activities such as enhancing immunity, managing diabetes, and regulating intestinal function. The current methods for RRFP extraction either have low extraction rates or are not conducive to scale-up applications; in addition, the effect of RRFP on improving SOP is unclear. RRFP with molecular weights ranging from 50 to 100 kDa was enriched by ultrafiltration, and was composed of fucose, rhamnose, arabinose, galactose, glucose, xylose, and galacturonic acid. The functional groups of polysaccharides were confirmed by Fourier transform infrared spectroscopy. Scanning electron microscopy revealed that RRFP exhibited a porous morphology. Notable increases in antioxidant capacity, dry femur weight, femur bone mineral density, and femur calcium levels were observed in RRFP group rats. Protein expression of keap1 decreased while HO-1 and Nrf2 increased after RRFP-Ca treatment. RRFP altered the composition of the intestinal microbiota in rats. RRFP could enhance calcium absorption to improve SOP by activating the Nrf2/HO-1 pathway and modulating the gut microbiota, especially by altering the abundance of Lachnospiraceae. © 2026 Society of Chemical Industry.

Hypertension poses a significant health risk for postmenopausal women, with incidence rates notably higher than for men of the same age group. The decline in estrogen levels leads to several physiological changes, such as hypocalcemia, which may contribute to the development of hypertension. This study investigates the effects of calcium supplementation on blood pressure control in postmenopausal women with hypocalcemia. We prospectively included 300 postmenopausal women diagnosed with both hypocalcemia and hypertension. The participants received calcium carbonate (1,000mg/day) in two daily doses, in addition to their standard antihypertensive treatment. Blood pressure measurements and serum calcium levels were recorded at baseline and after 3 months. Patients were divided into two groups according to serum calcium level at 3 months: those with normalized calcium levels and those who continued hypocalcemia. Women with persistent hypocalcemia at follow-up were younger at the age of menopause (mean age 48.65 years) compared to those who achieved normocalcemia (mean age 49.44 years), P = 0.017. Those who had normocalcemia had a significant SBP, DBP, and more patients achieved target blood pressure ( 0.017, 0.029 & 0.012), respectively. Use of calcium supplements to correct hypocalcemia in postmenopausal hypertensive women may help reduce blood pressure and achieve the target blood pressure.

Eldecalcitol is an active vitamin D3 derivative approved for the treatment of osteoporosis in Japan and postmenopausal osteoporosis in China. However, the impact of concomitant calcium supplementation on its safety profile is unclear. This was a prospective, observational, non-interventional post-marketing drug intensive monitoring study in Chinese postmenopausal women with osteoporosis (NCT05433207). Data were collected using an electronic case report form at baseline, before initial eldecalcitol dosing, and during routine clinical visits over a 1-year follow-up period. One thousand patients were enrolled from 29 Chinese clinical sites; 958 received eldecalcitol (853 without/105 with calcium supplementation). The mean age (standard deviation [SD]) of patients was 65.6 (9.0) years and mean (SD) time since osteoporosis diagnosis was 2.7 (3.8) years. Adverse drug reactions (ADRs) affected 39.2% and 42.9% of patients in the without and with calcium supplementation groups, respectively. 22 (2.3%) patients developed hypercalcemia including 17 (1.99%) and 5 (4.76%) in the without and with calcium supplementation groups, respectively. Multivariable logistic regression analyses indicated that those receiving calcium were more likely to experience hypercalcemia (adjusted odds ratio [OR] 3.07, 95% confidence interval [CI] 1.16, 8.10, P = 0.02) than those not receiving calcium. ADRs of urolithiasis were experienced by three patients (0.35%) in the without calcium supplementation group. This study confirmed the real-world safety profile of eldecalcitol in a large population of Chinese women with postmenopausal osteoporosis. Hypercalcemia incidence was higher in patients with compared to without calcium supplementation, indicating that concomitant eldecalcitol and calcium should be carefully considered.

MASH-induced elevation of FGF23 promotes hepatic osteodystrophy.

The impact of microbial transglutaminase modification on fish gelatin-maltodextrin gels loaded with calcium citrate and vitamin D3.

Osteoporosis is a major global health challenge, but treatment uptake and long-term adherence remain low, raising the risk of future fractures. Barriers to effective care include low patient awareness, financial constraints, and challenges with ongoing monitoring and follow-up. Although mobile health and telemedicine tools can support chronic disease management, many osteoporosis apps lack clinical validation and structured medication management features. This study aimed to evaluate the feasibility of implementing a newly developed web-based application, Wellhealth, to support osteoporosis treatment management. A secondary objective was to explore potential associations between patient demographic characteristics and the frequency of in-app medication logging over a 1-year period. We conducted a feasibility study at the Golden Jubilee Medical Center, Mahidol University, between January 2023 and March 2025. Participants were recruited using convenience sampling during routine outpatient osteoporosis clinic visits. Eligible patients with a primary osteoporosis diagnosis used the Wellhealth web-based system, including the Assisted Liaison Service feature, over a 1-year period. Weekly in-app reports of medication use, satisfaction, and related outcomes were analyzed. Feasibility outcomes were summarized using descriptive statistics. Potential associations between participant characteristics and consistent in-app medication logging were explored using univariable and multivariable logistic regression analyses. Differences between in-app medication logging rates and medication possession ratio values were summarized using medians and IQRs. We enrolled 32 participants with a mean age of 71 (range 58-91) years. The average in-app medication logging rate was 62.38% (SD 27.4%) for antiosteoporosis medications and 64.67% (SD 34.5%) for calcium supplementation. Vitamin D logging data were available for 27 participants, with an average logging rate of 68.23% (SD 31.6%). Overall satisfaction with the application was high, with 49% (15/32) of participants reporting high satisfaction, 42% (14/32) good, and 9% (3/32) average. User interaction increased markedly between the first and third quarters of 2023 before stabilizing through the second quarter of 2024. In multivariable analysis, consistent calcium logging was the only factor independently associated with higher antiosteoporosis logging rates (P=.02). Although younger age was associated with higher logging in univariable analysis (P=.01), this was no longer significant after multivariable adjustment (P=.12). Use of the Wellhealth system was feasible in this small cohort, with consistent medication logging, high user acceptability, and sustained digital engagement. Only consistent calcium logging was independently associated with higher antiosteoporosis medication tracking rates. Larger studies are needed to assess the app's clinical effectiveness and impact on long-term outcomes.

Intraoperative persistent severe hypotension (PSH) is a common complication following pancreaticoduodenectomy (PD) and may affect the prognosis of patients. The aim of this trial was to explore the ultrastructural alterations of capillary endothelia cells and relevant factors that is associated with PSH and postoperative outcomes in patients undergoing PD. Total 103 patients were divided into PSH or non-PSH group during PD. The basic clinical features, hemodynamic monitoring, electrolyte biochemical indexes, postoperative inflammatory biomarkers and adverse outcomes were analyzed. Particularly, the great omentum samples were collected and the morphological changes of capillary endothelial cells were revealed by electronic microscopy. PSH occurred in forty-four patients (42.7%) during PD. The PSH patients experienced greater extensive surgery scope, more bleeding, longer surgery time, increased fluid infusion and blood glucose. Hemodynamic monitoring revealed that the PSH patients primarily showed reduced vascular resistance with enhanced cardiac index. The postoperative inflammation biomarkers and incidence of postoperative complications in PSH group were significantly higher than those in non-PSH group (P < 0.05). Notably, the arterial plasma Ca2+ decreased significantly in PSH patients as that in non-PSH group (P < 0.001). Electron microscopy revealed in PSH patients ultrastructural evidence of capillary endothelial injury, including cellular swelling and increased pinocytotic activity. Endothelial cell permeability alteration and endothelial dysfunction might potentially reflect intensive surgical stress-inflammation-endocrine responses during PD. Endothelial edema formation and decreased plasma Ca2+ are probably associated with PSH and postoperative adverse outcomes of PD patients.Our study highlights the key point to keep the functionality and integrity of endothelia cells and timely supplement calcium to prevent PSH during pancreaticoduodenectomy and postoperative outcomes.

BackgroundWith the increasing burden of chronic diseases, self-management education (SME) is crucial. Traditional SME based on face-to-face delivery by clinicians is resource-intensive, and general digital tools such as web-based platforms often provide limited interactivity for patient learning. Although chatbots based on large language models (LLMs) show promise in interactivity, their real-world effectiveness lacks empirical evidence.ObjectiveThis study aimed to explore the feasibility and preliminary effectiveness of an LLM-based chatbot specifically designed for osteoporosis SME.MethodsA formative randomized controlled trial was conducted in a tertiary hospital from February 2024 to March 2025. Adults aged ≥18 years with osteoporosis were recruited and randomly assigned (1:1) to either the intervention (OPBot) group or a control group receiving traditional health education. The chatbot provided interactive educational content and question-and-answer support, while the control group received face-to-face education and written materials. Osteoporosis knowledge was assessed using the Osteoporosis Knowledge Assessment Tool at baseline and discharge. Nurses’ time spent on health education was self-recorded during each intervention session and aggregated across sessions. Adherence to disease management was assessed at 1, 3, and 6 months after discharge via telephone using Likert-scale questionnaires. The reliability of OPBot responses was evaluated by 2 clinician assessors using a 5-point Likert scale, with interrater agreement calculated using Cohen κ. Group comparisons were conducted using 2-tailed independent t tests, Mann-Whitney U tests, and chi-square tests, and adherence outcomes were analyzed using mixed-effects models.ResultsA total of 100 participants were randomized; 12% (12/100) were excluded due to loss to follow-up, refusal of the second knowledge assessment, or death, leaving 88% (88/100) participants for analysis (n=45, 51.1% in the OPBot group and n=43, 48.9% in the control group). The OPBot group showed significantly higher postintervention knowledge scores than the control group (median 80.0, IQR 70.0-89.0 vs median 75.0, IQR 65.5-80.0; P=.01). Nurses in the OPBot group spent lesser time on SME than those in the control group (median 5.0, IQR 2.0-17.0 vs median 23.0, IQR 20.0-25.0 minutes; P<.001). For adherence outcomes, a significant group×time interaction was observed for calcium supplement intake (odds ratio 1.49, 95% CI 1.08-2.06; P=.02), indicating differing adherence trajectories over time. The OPBot group also showed higher odds of consuming calcium-rich foods across time points (odds ratio 2.87, 95% CI 1.04-7.89; nominal P=.04), although this association did not remain significant after Holm correction. No significant effects were observed for sun exposure (P=.56), exercise (P=.79), or total adherence scores (P=.33). In the question-and-answer module, most OPBot responses were rated as highly reliable 89.4% (76/85), with high interrater agreement (Cohen κ=0.83).ConclusionsLLM-based chatbots specifically designed for osteoporosis SME may improve patient knowledge, supporting adherence behaviors, and reducing healthcare workload. However, further large-scale studies are needed to confirm these findings.

Calcium supplementation is widely used in older adults, but its long-term effects on cognitive function remain unclear. This study assessed the association between pharmacological calcium supplementation and cognitive decline over 7 years in cognitively healthy older women. This prospective cohort study included 227 women (mean age 79.9 ± 3.6 years) from the Toulouse centre of the EPIDOS study. Cognitive function was assessed using the Short Portable Mental Status Questionnaire (SPMSQ) at baseline and after 7 years. Cognitive decline was defined as a decrease of at least one point in SPMSQ score. Calcium supplement use at baseline was recorded. Multivariable logistic regression was used to evaluate the association between supplementation and cognitive decline, adjusted for age, obesity, physical activity, instrumental activities of daily living (iADL) score, education level, dietary calcium and vitamin D intake, number of comorbidities and selected chronic conditions. Cognitive decline occurred in 26% of participants. Calcium supplementation was reported by 12% of patients and was independently associated with an increased risk of cognitive decline (OR = 3.64; 95% CI: 1.47-9.01; p = 0.005). Obesity and comorbidity burden were also significant risk factors. Calcium supplementation was associated with a threefold increased risk of cognitive decline in older women over a 7-year follow-up. These results suggest caution in prescribing calcium supplements and underscore the need for further research on their neurological safety in ageing populations.

The effect of intravenous calcium administration on haemodynamics in perioperative cardiothoracic surgery and intensive care: A narrative review.

Title: Symptomatic hypocalcemia is uncommon in patients with liver disease undergoing low-volume plasma exchange by centrifugal technique.

Postsurgical hypoparathyroidism (HypoPT) accounts for ∼75% of all HypoPT cases. It is recognized that this condition is largely preventable. Several studies have identified risk factors increasing the risk of developing postsurgical HypoPT, including patient-related factors, surgical factors, and, in some studies, presurgical factors. This narrative review highlights evidence-based guidelines for postsurgical HypoPT and provides strategies for its prevention, diagnosis, and management. We searched PubMed, Embase, Google Scholar, and the Cochrane Library from inception through December 2025. We included studies that examined the definition, diagnosis, prevalence, risk factors, management, long-term complications, and treatment outcomes of postsurgical HypoPT. This review outlines strategies for identifying individuals at risk of developing postsurgical HypoPT, with the goal of minimizing these risks and using evidence-based approaches to accurately diagnose and effectively manage these patients. Historically, management of postsurgical HypoPT beyond the first 72 hours relied on calcium supplements with active vitamin D, which remains the first-line therapy in current practice. Parathyroid hormone (PTH) replacement has emerged as an option for individuals who do not respond to conventional therapy. More recently, a long-acting PTH molecule, palopegteriparatide, has been approved by the Food and Drug Administration for the management of HypoPT. This molecule has a 60-hour half-life and has demonstrated the ability to maintain normal serum calcium levels, lower urine calcium, lower serum phosphorus, and reduce the need for calcium and active vitamin D supplements. It has also demonstrated a positive impact on quality of life. Post hoc data from the phase 3 trial comparing palopegteriparatide with placebo demonstrated improvements in renal function with palopegteriparatide and cessation of conventional therapy in patients with HypoPT. Postsurgical HypoPT remains a significant complication of thyroid surgery; however, its risk can be mitigated by careful preoperative assessment and surgical technique. While conventional therapy continues to be the mainstay of treatment, the advent of PTH replacement therapies offers promising alternatives for patients with refractory HypoPT.

The chelation mechanism, stability and calcium absorption activity of Ruditapes philippinarum peptide‑calcium chelate.