Oral Calcium Intake Research Articles

Safety and Efficacy of Cinacalcet in Children Aged Under 3 Years on Maintenance Dialysis

BackgroundSecondary hyperparathyroidism (sHPT) is particularly severe in rapidly growing infants in dialysis. While cinacalcet is effective and licensed in dialysis above 3 years, its efficacy and safety below 3 years is unknown. MethodsWe identified 26 children on dialysis below three years treated with cinacalcet between 2009 and 2021 in 8 European pediatric centers. ResultsMedian (IQR) age at start of cinacalcet was 18[IQR 11–27] months, serum parathyroid hormone (PTH) was 792[411–1397] pg/mL, corresponding to 11.6[5.9–19.8] times the upper limit of normal (ULN). Serum calcium was 2.56[2.43–2.75] mmol/L, and serum phosphate 1.47[1.16-1.71] mmol/L. Serum 25-OHD was 70[60–89] nmol/L, three children were vitamin D deficient (<50nmol/L). The initial cinacalcet dose was 0.4[0.2–0.8] mg/kg/day and the maximum dose was 1.1[0.6–1.2] mg/kg/day. The median follow-up under cinacalcet was 1.2[0.7-2.0] years. PTH decreased to 4.3[2.2–7.8] times the ULN after 6 months, to 2.0[1.0–5.3] times ULN after 12 months and to 1.6[0.5–3.4] times thereafter (p=0.017/ 0.003/<0.0001, log-transformed PTH). Seven of the 26 infants developed 10 hypocalcemic episodes <2.10 mmol/L. Oral calcium intake was 84[66-117] % of recommended nutrient intake at start, 100[64-142] % at 3 months and declined to 78[65-102] % at 12 months of therapy. Three children developed clinical signs of precocious puberty. ConclusionCinacalcet efficiently controlled severe sHPT in children below 3 years of age and was associated with hypocalcemic episodes (similarly, to what is observed in older children) and precious puberty, mandating meticulous control of calcium (taking into account nutrition, supplementation and dialysate) and endocrine changes.

Calcium Challenge to Confirm Secondary Hyperparathyroidism Caused by Decreased Calcium Intake

ObjectiveSecondary hyperparathyroidism commonly occurs in the setting of mid-to low-normal serum calcium levels, often in the setting of chronic kidney disease, phosphate loading, vitamin D deficiency, or insufficient calcium intake or absorption. In this article, we report 9 patients who had adequate kidney function (estimated glomerular filtration rate >60 mL/min/1.73 m2) and normal 25-hydroxy vitamin D level (≥30 ng/dL) and whose secondary hyperparathyroidism resolved after starting adequate oral calcium intake. MethodsOur retrospective case series included 8 women and 1 man; the mean age was 69.0 ± 12.2 years (mean ± standard deviation). The initial intact parathyroid hormone (iPTH) level was 80.6 ± 13.4 pg/mL (reference range [ref], 10-65 pg/mL), corrected serum calcium level was 9.2 ± 0.2 mg/dL (ref, 8.5-10.5 mg/dL), serum phosphate level was 3.6 ± 0.4 mg/dL (ref, 2.5-4.9 mg/dL), 25-hydroxy vitamin D level was 42.2 ± 10.5 mg/dL (ref, 20-50 ng/mL), and estimated glomerular filtration rate was 72.6 ± 14.4 mL/min/1.73 m2. Patients were treated clinically with oral calcium 600 mg twice a day. ResultsiPTH was retested after a mean duration of 17.6 ± 12.7 days of calcium supplementation; the iPTH level decreased to 51.0 ± 10.6 pg/mL, with all patients achieving iPTH in the normal range with normocalcemia, consistent with hyperparathyroidism being because of insufficient calcium intake or absorption. All patients were normocalcemic after supplementation. ConclusionSecondary hyperparathyroidism can result from insufficient oral calcium intake. Calcium challenge is an efficacious and cost-effective tool for confirming and treating secondary hyperparathyroidism in the setting of normal vitamin D levels and kidney function.

Hypercalcaemia Caused by Sunflower Seeds and Calcium Carbonate Supplements.

Hypercalcaemia is commonly associated with malignancy or endocrinological disorders. However, sometimes it can occur due to increased oral intake of calcium. We present an interesting case of hypercalcaemia due to ingestion of sunflower seeds and calcium carbonate supplements. We present the case of a 53-year-old man with history of T-cell lymphoma and gastroesophageal reflux disease who was brought to the emergency room due to altered mental status, nausea, vomiting and abdominal pain. His calcium level was 3.30 mmol/l (normal value 2.23-2.58 mmol/l). Imaging studies were unremarkable. The patient was hydrated with normal saline and calcium levels improved. Once he was more coherent, he disclosed that he had consumed significant amounts of sunflower seeds and calcium carbonate supplements, which were considered to be the cause of his hypercalcaemia. Hypercalcaemia is common and can lead to critical illness. Although hypercalcaemia is frequently associated with endocrinological disorders, sometimes the presentation is secondary to increased intake. The consumption of sunflower seeds and antacids containing calcium carbonate can cause symptomatic hypercalcaemia. It is important to recognize rare causes of hypercalcaemia in order to treat it in a timely manner and prevent recurrence. Hypercalcaemia can occur due to excessive intake of sunflower seeds and calcium carbonate supplements.Hydration and cessation of oral supplements can result in rapid reversal of hypercalcaemia.It is important to obtain a complete history in order to determine the aetiology of hypercalcaemia.

Hypercalcaemia Caused by Sunflower Seeds and Calcium Carbonate Supplements

Introduction: Hypercalcaemia is commonly associated with malignancy or endocrinological disorders. However, sometimes it can occur due to increased oral intake of calcium. We present an interesting case of hypercalcaemia due to ingestion of sunflower seeds and calcium carbonate supplements. Case Description: We present the case of a 53-year-old man with history of T-cell lymphoma and gastroesophageal reflux disease who was brought to the emergency room due to altered mental status, nausea, vomiting and abdominal pain. His calcium level was 3.30 mmol/l (normal value 2.23–2.58 mmol/l). Imaging studies were unremarkable. The patient was hydrated with normal saline and calcium levels improved. Once he was more coherent, he disclosed that he had consumed significant amounts of sunflower seeds and calcium carbonate supplements, which were considered to be the cause of his hypercalcaemia. Conclusion: Hypercalcaemia is common and can lead to critical illness. Although hypercalcaemia is frequently associated with endocrinological disorders, sometimes the presentation is secondary to increased intake. The consumption of sunflower seeds and antacids containing calcium carbonate can cause symptomatic hypercalcaemia. It is important to recognize rare causes of hypercalcaemia in order to treat it in a timely manner and prevent recurrence.

The effects of implantation of hydroxyapatite into the tibia and oral calcium intake on structure of the humeral shaft

The effects of implantation of hydroxyapatite into the tibia and oral calcium intake on structure of the humeral shaft

Absence of callus two months after surgical fixation of a hip fracture in a patient with Paget’s disease

Introduction: Paget’s disease is a disorder of bone remodeling that typically begins with excessive bone resorption followed by an increased bone formation. This misbalance into new bone formation process and osteoclastic activity leads to a structurally disorganized mosaic of bone, which is mechanically weaker, larger, less compact, more vascular, and more susceptible to fracture than normal adult bone. Case description: We report the case of a 66-year-old woman who came to us due to a nonunion two months after surgical fixation of the right femoral neck fracture. Upon admission, a pelvic radiograph revealed right femoral neck fracture with osteolysis. A biopsy of the greater trochanter demonstrated histopathological patterns of Paget’s disease. After the surgical intramedullary metallic osteosynthesis of the femoral neck, the patient left the hospital suggested for physiotherapeutic treatment with quadriceps isometric exercises. After 2 months, the pelvic X-ray revealed absence of callus, and the patient was referred to a rheumatologist. Intravenous administration of bisphosphonates (zoledronic acid), as well as oral intake of calcium and vitamin D has been prescribed. Conclusions: Besides rheumatologists and endocrinologists, clinical recognition of Paget’s disease is also very important for orthopedic surgeons in order to achieve better results for patients suffering from any kind of major osteoporotic fracture.

Calcium and phosphorus metabolism in peripartal dogs.

Recommended allowances for calcium and phosphorus are mostly based on factorial calculations partly set at the level determined adequate for giant breeds (Nutrient requirements of dogs and cats. Washington, DC, USA: The National Academies Press. 2006). Information about appropriateness of supply with both minerals during the peripartal phase is limited. From other species is known that bone mineral stores are used in addition to oral intake of calcium and phosphorus in periods of higher needs such as gestation and lactation. The aim of this study was to determine parameters of calcium and phosphorus homeostasis in female dogs receiving the recommended amount of these minerals according to NRC (Nutrient requirements of dogs and cats. Washington, DC, USA: The National Academies Press. 2006) during the peripartal phase. In five Beagles and four Foxhound crossbreds, all primiparous with a litter size of 1-8 puppies, apparent digestibility of calcium and phosphorus as well as serum parameters of mineral metabolism (total and ionised calcium, phosphorus, parathyroid hormone, bone specific alkaline phosphatase, crosslaps) was determined in the period of 12-9days before and 4-9days after parturition. The apparent digestibility of calcium was relatively low and did not differ significantly between both peripartal phases, whereas the apparent digestibility of phosphorus increased during lactation. Serum concentrations of calcium (total as well as ionised), phosphorus and parathyroid hormone did not differ between gestation and lactation. The bone resorption marker serum crosslaps increased in lactating dogs but most individual values were within the reference range for adult female dogs at maintenance. On the other hand, the bone formation marker bone specific alkaline phosphatase decreased from prepartal to postpartal phase with values clearly above reference range in both phases. Based on the results especially of the bone markers, which stayed within the reference range during the peripartal phase without indicating predominant bone resorption, we hypothesise that the applied recommended daily allowances defined for peripartal dogs are appropriate.

Effects of oral iron and calcium supplement on the pharmacokinetics and pharmacodynamics of molidustat: an oral HIF\u2013PH inhibitor for the treatment of renal anaemia

PurposeThe present studies assessed the drug–drug interaction of molidustat, a hypoxia-inducible factor prolyl hydroxylase inhibitor, with iron and calcium supplements, which are common medications in patients with anaemia due to chronic kidney disease (CKD).MethodsForty-two healthy men received molidustat alone (fasted or fed) or combined with oral iron(II) or calcium(II), given immediately before or between 4 h before and 1 h after molidustat in three randomized, open-label, crossover studies (12–15 participants per study). Molidustat AUC and Cmax were assessed as the main pharmacokinetic parameters, and endogenous erythropoietin (EPO) was measured to evaluate pharmacodynamics.ResultsDepending on prandial state, concomitant intake of iron(II) reduced molidustat AUC and Cmax by 50–75% and 46–84%, respectively, and EPO AUC(0-24) and Cmax by 31–44% and 36–48%, respectively. The influence of iron(II) declined with increasing the time interval to the intake of molidustat, with reductions in molidustat AUC and Cmax of 9% and 10%, respectively, when iron(II) intake occurred 4 h before molidustat. Accordingly, effects on endogenous EPO were less pronounced with increased time separation between oral iron(II) and molidustat intake. Calcium(II) reduced molidustat AUC and Cmax by 15% and 47%, respectively, without influence on EPO response. All treatments were well tolerated.ConclusionsIn contrast to concomitant oral intake of calcium, the effect of oral iron supplements on molidustat pharmacokinetics and pharmacodynamics should be considered, and the two agents should be administered with an appropriate time separation.

Alternate-day calcium dosing may be an effective treatment option for chronic hypoparathyroidism.

Conventional treatment of chronic hypoparathyroidism consists of oral calcium supplements and active vitamin D analogs; however, some patients are unable to meet treatment goals despite the high dosage of oral calcium supplementation. We aimed to investigate the effectiveness of alternate-day oral calcium intake in patients with uncontrolled chronic hypoparathyroidism. In this retrospective cohort study, we evaluated 66 patients with chronic hypoparathyroidism who were admitted to our hospital between January 2017 and January 2019. Fourteen patients receiving ≥ 2000mg/day oral elemental calcium and who were admitted to emergency department or our outpatient clinic at least once in the last 3months for hypocalcemia requiring intravenous calcium replacement were switched to the alternate-day dosing regimen in which patients took calcium orally every other day. We collected and analyzed patients' medical history information, serum and urinary parameters over a 3-month period prior to and following the treatment. Before alternate-day dosing regimen, median oral calcium intake was 3750mg/day, oral calcitriol intake was 0.88mcg/day, serum calcium levels were 7.71mg/dL, serum phosphate levels were 5.35mg/dL, and 24-h urine calcium levels were 165mg/day. Following alternate-day dosing regimen, median oral calcium intake was 1500mg/day, oral calcitriol intake was 0.88mcg/day, serum calcium levels were 8.25mg/dL, serum phosphate levels were 5mg/dL, and 24-h urine calcium levels were 210.5mg/day. After alternate-day dosing regimen, oral calcium intake decreased and serum calcium levels increased. The number of emergency visits dropped from 21 to 3 after alternate-day dosing regimen. Patients with uncontrolled chronic hypoparathyroidism could be controlled more effectively with alternate-day dosing regimen.

Calcium Supplementation: A Review of Oral Calcium Intake on Human Health

A frequently asked question by a healthy, young lady presenting with a limb fracture being managed conservatively with immobilisation in a plaster is “Should I take Calcium supplementation so that my fracture heals well?.”

MON-534 Reduced PTH Levels in Adolescents with Anorexia Nervosa: Implication for Kidney and Bone

Background: Patients with anorexia nervosa (AN) experience bone as well as kidney complications including low bone mineral density (BMD), increased fracture rate, kidney stones, hypercalciuria and chronic renal failure. However, the mechanisms of those complications are not fully understood (1). The aim of this study is to investigate the interrelationship of central measures of calcium vitamin D metabolism and bone and kidney health in adolescents with newly diagnosed AN. Methods: This is a cross-sectional study that included newly diagnosed adolescents with AN referred to the Eating Disorder Program (EDP) at the Hospital for Sick Children over a two-year period. In addition to demographic and auxiological data, information on vitamin D and calcium intake was obtained. BMD and blood and urine samples for central measures of calcium vitamin D metabolism were investigated. In addition to descriptive statistics, multiple linear regression was performed to examine the association between PTH and various predictors. Results: A total of 61 patients (55 female, 6 male, mean age 15.2 ± 1.56 years) were included. Overall levels of serum calcium, phosphate, magnesium and 25-hydroxyvitamin D (25OHD) were normal and urinary calcium to creatinine ratio was increased (0.87 ± 0.47mmol/mmol, normal<0.7). However, a novel observation was made regarding low PTH levels in 35% of this cohort (<22ng/L, normal 22-88ng/l (2)). Low PTH levels did not appear to be a result of partial or complete hypoparathyroidism (normal calcium and phosphate levels), oral calcium intake (no significant correlation, p= 0.59) or magnesium deficiency (normal magnesium levels). As previously described, a significant negative correlation between PTH and 25OHD levels below 100 nmol/L was noted (p=0.007). However, 25OHD levels in the range of 100-200 nmol/L, did not contribute to the lower PTH levels (p= 0.39). Mean lumbar spine (L2-4) BMD Z-score was -0.69 ± 1.14. Conclusion: This study indicates reduced PTH levels in 1/3 of adolescents with AN at presentation to a tertiary care EDP. As in previous studies (1), this data suggests that the reduction in PTH may be due to a subtle increase in ionized serum calcium resulting from reduced bone formation and reduced mineralization with ongoing bone resorption. Reduced PTH levels in these patients may contribute to both the renal and bone complications in AN.

The Key Role of Phosphate on Vascular Calcification.

Vascular calcification (VC) is common in dialysis and non-dialysis chronic kidney disease (CKD) patients, even in the early stage of the disease. For this reason, it can be considered a CKD hallmark. VC contributes to cardiovascular disease (CVD) and increased mortality among CKD patients, although it has not been proven. There are more than one type of VC and every form represents a marker of systemic vascular disease and is associated with a higher prevalence of CVD in CKD patients, as shown by several clinical studies. Major risk factors for VC in CKD include: Increasing age, dialysis vintage, hyperphosphatemia (particularly in the setting of intermittent or persistent hypercalcemia), and a positive net calcium and phosphate balance. Excessive oral calcium intake, including calcium-containing phosphate binders, increases the risk for VC. Moreover, it has been demonstrated that there is less VC progression with non-calcium-containing phosphate binders. Unfortunately, until now, a specific therapy to prevent progression or to facilitate regression of VC has been found, beyond careful attention to calcium and phosphate balance.

Calcium Metabolism and Skeletal Changes during Pregnancy and Lactation.

Calcium metabolism changes dramatically during pregnancy and lactation because offspring needs a supply of calcium. Approximately 30g of calcium, which passes through the placenta, is accumulated in a fetus during pregnancy mostly in the third trimester, and 220-340mg/day of calcium is supplied via breast milk during lactation. However, there are elaborate mechanisms to maintain maternal calcium homeostasis, which differs during pregnancy and lactation. Extra required calcium supply to the offspring in neither pregnancy nor breastfeeding normally do not cause any adverse consequences to the maternal skeleton even if any oral intake of calcium or vitamin D are increased. This article reviews the adaptation in calcium kinetics during pregnancy and lactation. Vitamin D, calciotropic hormones, and bone metabolism are also reviewed.

Rationale to reduce calcium intake in adult patients with chronic kidney disease.

Calcium is an essential ion for the maintenance of normal bone health and physiologic functions. The extracellular and intracellular levels of calcium are maintained through hormonal regulation called homeostasis. Balance, the net intake minus excretion of calcium, is maintained by hormonal regulation of intestinal absorption and fecal/urinary excretion. Homeostasis and balance are disconnected in patients with chronic kidney disease (CKD). The purpose of this review is to understand how calcium homeostasis and balance are impaired in CKD. Two formal calcium balance studies have found that an oral intake of 800-1000 mg of calcium in adults with CKD leads to neutral calcium balance, whereas amounts greater than that lead to positive calcium balance. In patients with CKD, the main determinant of positive calcium balance is the intake and the lack of urinary calcium excretion. Calcium balance is different in patients with advanced CKD compared with patients without CKD. Thus, the oral intake of calcium in the form of diet and binders should not exceed 800-1000 mg/day to achieve neutral calcium balance in adult patients with CKD stages 3b/4.

Impact of intercurrent illness on calcium homeostasis in children with hypoparathyroidism: a case series.

BackgroundHypoparathyroidism is characterised by hypocalcaemia, and standard management is with an active vitamin D analogue and adequate oral calcium intake (dietary and/or supplements). Little is described in the literature about the impact of intercurrent illnesses on calcium homeostasis in children with hypoparathyroidism.MethodsWe describe three children with hypoparathyroidism in whom intercurrent illnesses led to hypocalcaemia and escalation of treatment with alfacalcidol (1-hydroxycholecalciferol) and calcium supplements.ResultsThree infants managed with standard treatment for hypoparathyroidism (two with homozygous mutations in GCMB2 gene and one with Sanjad-Sakati syndrome) developed symptomatic hypocalcaemia (two infants developed seizures) following respiratory or gastrointestinal illnesses. Substantial increases in alfacalcidol doses (up to three times their pre-illness doses) and calcium supplementation were required to achieve acceptable serum calcium concentrations. However, following resolution of illness, these children developed an increase in serum calcium and hypercalciuria, necessitating rapid reduction to pre-illness dosages of alfacalcidol and oral calcium supplementation.ConclusionIntercurrent illness may precipitate symptomatic hypocalcaemia in children with hypoparathyroidism, necessitating increase in dosages of alfacalcidol and calcium supplements. Close monitoring is required on resolution of the intercurrent illness, with timely reduction of dosages of active analogues of vitamin D and calcium supplements to prevent hypercalcaemia, hypercalciuria and nephrocalcinosis.

Analysis of the kinetics of the parathyroid hormone, and of associated patient outcomes, in a cohort of haemodialysis patients.

BackgroundObservational studies have recently associated a decrease in serum parathyroid hormone (PTH) level with a higher rate of mortality among hemodialysis (HD) patients. Decreases in PTH level can result from medical intervention (MPD) and surgical parathyroidectomy (PTX), or may occur spontaneously, usually associated with an underlying malnutrition-inflammation syndrome (SPD). The aim of our study was to prospectively identify the incidence of decreases in PTH level in a cohort of HD patients and the frequency distribution of the different causes (MPD, PTX and SPD), as well as to evaluate the survival outcomes for each PTH group (MPD, PTX and SPD) compared to patients who did not experience a PTH decrease over the first 36 months of the study (NPD).MethodsThe 197 patients receiving HD at our center in January 2010, and meeting our eligibility criteria, were enrolled in our prospective study, and were observed for a period of 60 months. A decrease in PTH level >50 % between two successive PTH measurements obtained within an interval <3 months was defined as a significant event. MPD referred to a decrease in PTH due to an increased oral calcium intake, increased dialysate calcium concentration (DCC), increased alfacalcidol use, or use of cinacalcet therapy. A surgical 7/8 PTX was performed in young patients or in patients in whom cinacalcet therapy failed. SPD referred to a decrease in PTH related to a medical or surgical event. Baseline characteristics among patients in each group (MPD, PTX, SPD, and NPD) were evaluated using Fisher’s exact test. The 60-month survival was evaluated using Kaplan-Meier and Cox multivariable proportional hazards models. Univariate and multivariate Cox analyzes were used identify variables with mortality. The relative risk of mortality was expressed as a hazard ratio (HR).ResultsThe distribution of the 197 patients forming our four study groups was 34 % in the NPD group, 35 % in the SPD group, 25 % in the MSD group and 6 % in the PTX group. Among patients in the SPD group, the main acute comorbid conditions were peripheral vascular and cardiac complications, sepsis, fractures, and cancers with an increase in serum CRP level (from 14.3 ± 18 to 132 ± 90 mg/L) and a decrease in serum albumin (from 33 ± 4.5 to 28.6 ± 4 g/L). In the MPD group, the main therapeutic change was an increase in DCC, either independently or in association with cinacalcet therapy. The median survival rate among patients was 10 months for SPD, compared to 22 months among patients in the MPD group (p < 0.001). Using multivariable Cox model and taking the NPD group as reference, the risk of mortality was lower among patients in the MPD group (HR, 0.42[0.2-0.87] p = 0.01), with survival being comparable for the SPD and NPD groups (HR, 1.3 [0.75-2.2]). No mortality was observed in the PTX group.ConclusionThe poor outcomes associated with SPD, related to acute comorbid conditions, should not lead to undertreat secondary hyperparathyroidism whose appropriate medical or surgical therapies are associated with better outcomes.

Association of oral calcium intake with osteoarthritis progression and knee replacement: Data from the Osteoarthritis Initiative

Association of oral calcium intake with osteoarthritis progression and knee replacement: Data from the Osteoarthritis Initiative

Teriparatide for the treatment of adynamic bone disease in chronic kidney disease patients

A Bone Disease (ABD) is characterized by low bone turnover and absence or a reduced number of osteoblasts and osteoclasts and its prevalence in Chronic Kidney Disease (CKD) patients is increasing steadily over the last years. This high prevalence has been attributed to many factors, such as diabetes, use of drugs down-regulating parathormone release, high calcium intake, advanced age and chronic inflammation. Treatment of ABD imposes a serious challenge, since this condition is accompanied by a considerable increase in fracture risk and mortality. Current treatment concepts focus on limiting daily oral calcium intake as well as intra-dialytic calcium but reliable guidelines are lacking. Administration of teriparatide, the recombinant N-terminal region of human parathyroid hormone (PTH1−34), would theoretically improve ABD in CKD patients, since in these patients the condition is attributed to PTH deficiency or an intrinsic bone resistance to PTH. However, the use of this agent in CKD is limited to 2 small studies which showed that teriparatide treatment may increase bone mineral density, assessed by bone densitometry. Moreover, there are two case reports, one from our group, which showed that this treatment restored bone metabolism assessed by bone histomorphomery. Furthermore, it has been demonstrated that the pharmacokinetics of teriparatide in hemo-dialysis patients are similar to those observedamong postmenopausal women with normal kidney function, likely due to hepatic clearance of the drug. Large prospective randomized controlled trialsin CKD patients are urgently needed to determine the safety and efficacy of teriparatide administration and the optimal duration of treatment.

Allogeneic parathyroid: 2-year follow-up

Abstract Background Hypoparathyroidism is one of the most frequent complications of neck surgery. The treatment is currently medical; however this involves several complications secondary to high doses of calcium and vitamin D, thus making parathyroid allotransplantation a good management option. Material and methods Patients with hypoparathyroidism were selected in the April-December period of 2011 in the general surgical clinic. They were between 16 and 65 years, and ingested high doses of calcium. The donors were patients with primary and secondary hyperparathyroidism, and the transplants were performed in relation to blood group and human leucocyte antigen. Results Five parathyroid allografts were performed. All the patients had iatrogenic hypoparathyroidism, all women with a mean age of 49.8 years. The graft was implanted under local anaesthesia in the non-dominant forearm. Four of the patients are so far considered functional due to the increase in paratohormone, and demonstrating its function by scintigraphy with sestamibi. One of the patients showed no increase in paratohormone or imaging studies that demonstrate its functionality. After a two year follow-up the graft remains functional but with oral calcium intake at a lower dose than before transplantation. None of the patients had immunosuppression side effects. Conclusions In this study, allogeneic unrelated living parathyroid transplant with an immunosuppressive regimen of six months has proven to be a safe alternative treatment to improve quality of life by decreasing the excessive calcium intake and improving physical activity with adequate graft survival at 24 months follow-up.

Alotrasplante de paratiroides: seguimiento a 2 años

BackgroundHypoparathyroidism is one of the most frequent complications of neck surgery. The treatment is currently medical; however this involves several complications secondary to high doses of calcium and vitamin D, thus making parathyroid allotransplantation a good management option. Material and methodsPatients with hypoparathyroidism were selected in the April-December period of 2011 in the general surgical clinic. They were between 16 and 65 years, and ingested high doses of calcium. The donors were patients with primary and secondary hyperparathyroidism, and the transplants were performed in relation to blood group and human leucocyte antigen. ResultsFive parathyroid allografts were performed. All the patients had iatrogenic hypoparathyroidism, all women with a mean age of 49.8 years. The graft was implanted under local anaesthesia in the non-dominant forearm. Four of the patients are so far considered functional due to the increase in paratohormone, and demonstrating its function by scintigraphy with sestamibi. One of the patients showed no increase in paratohormone or imaging studies that demonstrate its functionality. After a two year follow up the graft remains functional but with with oral calcium intake at a lower dose than before transplantation. None of the patients had immunosuppression side effects. ConclusionsIn this study, allogeneic unrelated living parathyroid transplant with an immunosuppressive regimen of six months has proven to be a safe alternative treatment to improve quality of life by decreasing the excessive calcium intake and improving physical activity with adequate graft survival at 24 months follow up.