Parathyroid Hormone Research Articles

BackgroundParathyroid hormone plays a key role in muscle metabolism and function, yet its precise association with sarcopenia remains controversial. This meta-analysis evaluated the relationship between serum parathyroid hormone levels and the risk of sarcopenia.MethodsWe systematically searched PubMed, Embase, and Web of Science until April 2025 for observational studies on the link between parathyroid hormone levels and sarcopenia. Using random-effects models, we derived pooled odds ratios with 95% confidence intervals and conducted subgroup analyses. Sensitivity analyses were performed to ensure robustness by excluding small or low-quality studies. Study quality was assessed with modified Newcastle–Ottawa scales, and publication bias was checked using funnel plot symmetry.ResultsThis meta-analysis included 11 studies involving 4,759 participants, with mean ages ranging from 57.5 to 76.4 years and 50.37% of participants being female. Our meta-analysis showed a positive association between serum parathyroid hormone levels and the risk of sarcopenia (odds ratios = 1.10, 95% confidence intervals 1.03–1.17, P < 0.001). Subgroup analyses indicated a consistently positive association across diagnostic definitions and study settings, although the effect size was greater in studies using alternative diagnostic criteria (OR = 1.94, 95% confidence intervals 1.21–3.13) and in hospital-based populations (OR = 2.19, 95% confidence intervals 1.27–3.77). Sensitivity analysis confirmed the stability of these findings, with no publication bias detected.ConclusionsThis meta-analysis suggests a potential positive association between elevated parathyroid hormone levels and sarcopenia risk. However, given the substantial heterogeneity and the observational nature of the included studies, these findings should be interpreted with caution. Further large-scale, prospective investigations are warranted to clarify the causal relationship and to explore whether targeting parathyroid hormone could contribute to sarcopenia prevention or management.Supplementary InformationThe online version contains supplementary material available at 10.1186/s13018-025-06405-8.

Expression of fibroblast growth factor 23 (FGF23) and αKlotho in two commercial laying hen strains fed with and without dietary mineral P supplements before and after the onset of the laying phase.

An underdiagnosed manifestation: Mandibular bone loss in primary hyperparathyroidism.

Intraoperative identification of parathyroid adenomas can be challenging due to their anatomical variability and the limitations of preoperative imaging. This study aimed to evaluate the impact of indocyanine green (ICG) fluorescence imaging on operative efficiency and surgical outcomes in parathyroidectomy, employing a standard near-infrared (NIR) endoscopic system. We conducted a prospective interventional study with retrospective controls. Patients undergoing parathyroidectomy for primary hyperparathyroidism were included. The study group received intravenous ICG for intraoperative fluorescence imaging to aid parathyroid gland identification. Standard protocols, including preoperative imaging, intraoperative quick parathyroid hormone (qPTH) measurements, and frozen section analysis, were followed in both groups. Operative times and clinical outcomes were compared between ICG-assisted and standard procedures. Seventy-six patients were included: 19 in the ICG group and 57 in the control group. The median net operative time (cutting-to-end) was significantly shorter in the ICG group (59 vs. 79min; p = 0.002), while entry-to-cutting time was slightly longer (44 vs. 35min; p = 0.014). Although the total operative time was shorter in the ICG group (109 vs. 123min), this difference was not statistically significant (p = 0.060). A ≥ 50% reduction in qPTH was achieved in 94.7% vs. 89.5% (p = 0.672), and adenoma confirmation was 100% vs. 96.5% (p = 1.0), respectively. ICG fluorescence is a cost-effective adjunct to standard parathyroidectomy, offering real-time gland visualization and potentially reducing operative times. Its integration into the routine surgical workflow may enhance intraoperative efficiency and outcomes.

Intraoperative parathyroid hormone monitoring criteria in secondary and tertiary hyperparathyroidism: A systematic review

Background/Objectives: Despite its increasing incidence in older patients, parathyroidectomy for primary hyperparathyroidism (PHPT) is frequently deferred owing to risks and age-related comorbidities and the limited evidence of age-specific surgical safety and biochemical outcomes. We evaluate age-related differences in clinical characteristics, perioperative outcomes, postoperative complications, and biochemical responses, including bone turnover markers, after parathyroidectomy for PHPT. Methods: We retrospectively enrolled 596 patients who underwent parathyroidectomy between 2009 and 2022, stratified into three age groups: &lt;65, 65–74, and ≥75 years (Group A, n = 401; Group B, n = 141; and Group C, n = 54, respectively). Demographics, comorbidities, operative details, complications, pathology, and biochemical parameters were compared between the groups. Results: Older patients exhibited a higher prevalence of hypertension, cardiovascular disease, diabetes, osteoporosis, and chronic kidney disease (all p &lt; 0.01), whereas multiple endocrine neoplasias were more frequent in younger patients (p = 0.002). Younger patients had a longer operation time (p = 0.006). There were no significant intergroup differences in postoperative hospital stay and complication rates, including transient hypoparathyroidism, hungry bone syndrome, and recurrent laryngeal nerve injury. Pathologic diagnoses were comparable, with single adenoma being most common (81.0–86.2%). The postoperative calcium and parathyroid hormone levels normalized in all groups. Younger patients had higher baseline bone turnover markers and demonstrated greater absolute reductions postoperatively (p = 0.030 and p = 0.042, respectively); however, improvements were observed in all age groups. Conclusions: When appropriately selected, parathyroidectomy is safe and effective in all age groups, including older patients with comorbidities. Considering its evident biochemical and skeletal benefits, age should not preclude surgical intervention for PHPT.

ObjectiveFew studies have examined the relationship between vitamin D and parathyroid hormone (PTH) in school-aged children with cow’s milk protein allergy (CMPA). This study aimed to investigate the role of vitamin D on PTH in this population.MethodsData for this cross-sectional analysis were obtained from the 2005–2006 National Health and Nutrition Examination Survey database. XGBoost and Random Forest models were employed to explore the importance of vitamin D on PTH. Multi-factorial linear regression analysis, Pearson correlation analysis, and quantile regression were conducted. Sensitivity analyses, including trend regression, stratified analyses, generalized additive model (GAM), and polynomial regression analyses, were used to verify the stability of their association.ResultsThe median level of PTH in 238 children was 35.000[27.000,45.000] pg/mL, and 38.235% of participants had vitamin D insufficiency and deficiency. XGBoost and Random Forest models identified vitamin D as the most significant factor influencing PTH levels. Multi-factorial linear regression analysis revealed that lymphocytes and vitamin D were independent influencing factors on PTH. Pearson correlation and quantile regression analyses suggested that the absolute value of the correlation coefficient between vitamin D and PTH was higher than that between lymphocytes and PTH (-0.323 vs. 0.151). Sensitivity analyses confirmed the correlation stability of vitamin D and PTH.ConclusionIn the CMPA school-aged children, 38.235% exhibited vitamin D insufficiency and deficiency. Vitamin D level was significantly and independently related to PTH levels.

Normo-calcemic primary hyperparathyroidism (NHPT) is a disorder in which elevated parathyroid hormone (PTH) is the result of autonomic hypersecretion of parathyroid hormone from 1 or more parathyroid glands, and the serum calcium levels are consistently within the normal range. A 65-year-old diabetic woman presented with recurrent upper abdominal pain for 5 months, progressively increasing in severity, and was diagnosed with chronic pancreatitis with FCPD, depending on biochemical and radiological findings. Investigations revealed a normal serum calcium level (9.5 mg/dl), low phosphate level (2.3 mg/dl), persistently high parathyroid hormone (PTH) level (785.8 pg/ml), normal serum creatinine (0.93 mg/dl), severely low serum vitamin D (9.37 ng/ml), high alkaline phosphatase (206 U/L), elevated blood glucose (RBS-12.9), normal liver and thyroid functions. Ultrasonogram and CT scan of the abdomen revealed an atrophic pancreas, dilated major pancreatic duct (MPD) with multiple calculi in the lumen, pancreatic calculi &amp; lipomatosis. SPECT Tc99m-MIBI scan was positive for a hyperactive parathyroid adenoma (left-inferior), suggesting PHPT from a hyperactive single parathyroid adenoma. The presence of normocalcemia in the case of PHPT with parathyroid adenoma raises a diagnostic dilemma. A severely low serum vitamin D level may explain the normal serum calcium level despite a very high PTH stimulation. FCPD also contributed to a normal calcium level despite high PTH. After exclusion of secondary causes, the diagnosis of PHPT was confirmed. After several literature reviews, vitamin D therapy was given as the serum calcium level was just in the normal range with no risk of hypercalcemia. A minimally invasive parathyroid surgery is planned to remove the parathyroid adenoma with preservation of other parathyroid glands to avoid any incidence of hungry bone syndrome. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S65]

BACKGROUND: Many genetic factors are known to be related to osteoporosis, and currently the role of the glucagon-like peptide-1 receptor (GLP-1R) gene in bone health has been studied intensively. Some variation of this gene, such as rs1042044 and rs6458093, are known to be linked to metabolic diseases and lower bone mineral density, however their specific contribution to osteoporosis remains largely unexplored. Therefore, this study was conducted to investigate the combined genotypic effect of rs1042044 and rs6458093 as a genetic risk factor for osteoporosis in postmenopausal Iraqi women.METHODS: Blood samples from 75 osteoporosis patients and 75 healthy controls, aged 45-85, were collected. DNA was extracted, and a region of GLP-1R gene was amplified by polymerase chain reaction (PCR) and sequenced using the Sanger method to identify polymorphisms. Serum parathyroid hormone (PTH) levels were also measured with chemiluminescent immunoassay (CLIA) methods.RESULTS: Significant differences were observed for age, menopausal age, and PTH levels (p&lt;0.001), but not for Body Mass Index (BMI). While individual SNPs (rs1042044 and rs6458093) showed no significant association with osteoporosis, a specific genotype combination of rs1042044 A and rs6458093 G was found to be a highly significant risk factor for the disease (OR=21.85, p=0.026). Linkage Disequilibrium analysis showed a D' value=0.85 and R²=0.45 between the two SNPs.CONCLUSION: Co-occurrence of the 'A' allele at rs1042044 and the 'G' allele at rs6458093 creates a highly susceptible genetic risk factor for osteoporosis, highlighting a potential novel biomarker for disease risk and providing a benchmark for future studies.KEYWORDS: osteoporosis, postmenopausal, GLP1R, PTH, SNPS

Relevance. Evaluation of mineral metabolism markers in mixed saliva may be a non-invasive method for diagnosing potential disorders and developing strategies for the prevention and treatment of dental diseases in children with hypophosphatasia (HPP). Objective: To determine the content of vitamin D, osteocalcin (OCC), osteoprotegerin (OPT), bone-specific alkaline phosphatase (BSAP), and parathyroid hormone (PTH) in mixed saliva and to study their relationships with some clinical parameters of dental status in children with HPP. Materials and Methods. Twenty children with HPP, aged 6–17 years, and 20 healthy children of the same age were examined. Caries intensity and structural and functional caries resistance of enamel in permanent teeth were assessed using the KPU index and the TER test, respectively; periodontal tissue condition was determined using the PMA index. The content of vitamin D, TBPC, OPT, and IAP were determined using enzyme-linked immunosorbent assay (ELISA). Results. Clinical evaluation of key dental parameters in children with HPP and healthy children revealed insufficient oral hygiene associated with an increase in caries in permanent teeth and the presence of moderate gingivitis. In the laboratory phase of the study, a statistically significant difference (2-fold) in the mixed saliva of children with HPP was found in a two-fold decrease in IAP secretion. Reduced levels of vitamin D concentration and OPT minute secretion in mixed saliva in children with HPP are associated with the development of caries in permanent teeth and soft tissue inflammation. Conclusions. The identified changes in biochemical parameters (IBP, vitamin D, OPT, and OPT) in mixed saliva allow us to recommend them as markers for identifying the risk of impaired formation and mineralization of dental and periodontal tissues in children with hypophosphatasia.

Familial hypocalciuric hypercalcemia (FHH) is a rare, usually benign, autosomal dominant disorder caused by mutations in the calcium-sensing receptor (CaSR) gene. It is typically characterized by mild, lifelong hypercalcemia, relative hypocalciuria, and normal or mildly elevated parathyroid hormone levels. Here we present a case of a 38-year-old male with newly diagnosed diabetes mellitus for 3 months who had recurrent episodes of acute pancreatitis for the last 1 year. Recurrent pancreatitis, a recognized complication of primary hyperparathyroidism, has rarely been reported on FHH, which made our case a unique one. Studying the case might help to develop insight into the diagnosis and management of this rare entity. [J Assoc Clin Endocrinol Diabetol Bangladesh, 2025;4(Suppl 1): S56]

Parathyroid hormone (PTH), produced by the parathyroid glands, plays a critical role in the regulation of calcium and phosphate homeostasis, acting primarily on bone and kidney to maintain serum calcium levels within a narrow range. Parathyroid hormone also plays important roles in bone remodeling by directly stimulating osteoblasts and osteocytes, integrating its calcemic response with stimulation of bone formation. Through the RANK/RANK-ligand system, these cells activate osteoclasts, promoting a balanced process of bone formation and resorption that maintains bone density and strength. Dysregulation of PTH, as seen in disorders such as hyper- and hypoparathyroidism, can lead to significant clinical complications. In recent years, major advancements have been made in the development of PTH analogs, aimed at leveraging PTH's physiological effects on bone to treat conditions such as osteoporosis and hypoparathyroidism. While PTH promotes both bone formation and bone resorption, the net outcome may be a gain or loss of bone mass, depending largely on the administration pattern of PTH or its analogs. When PTH is given intermittently (eg, as once-daily subcutaneous injection), bone formation is favored. Continuous administration of PTH or chronic elevation of blood PTH levels as seen in primary hyperparathyroidism tend to promote bone resorption. Parathyroid hormone analogs, such as teriparatide (PTH(1-34)) and the PTHrP analog abaloparatide, administered once daily, have significant efficacy in stimulating bone formation, making them valuable options for the treatment of osteoporosis. Given this capacity to improve bone structure, these analogs hold broader therapeutic potential for other skeletal disorders, including fracture healing and oral bone repair, which expands the scope of PTH-based therapies beyond osteoporosis. Long-acting PTH analogs have applications in treating hypoparathyroidism, offering an alternative to conventional treatment with calcium and active vitamin D. This article reviews the molecular mechanisms of approved and emerging PTH-based medicines, their clinical applications, and recent advances in optimizing their therapeutic potential. We also discuss ongoing research aimed at developing next-generation PTH analogs with improved efficacy for skeletal and metabolic disorders.

Robotic thyroidectomy via the bilateral axillo-breast approach (BABA) provides excellent cosmetic outcomes, but its adoption is limited by a steep learning curve and concerns about functional safety. This study aimed to define the learning curve trajectory and evaluate functional safety outcomes-with the primary endpoint of intraoperative RLN adverse events and secondary endpoints of inadvertent parathyroidectomy and PTH recovery. A prospective cohort study was conducted at a high-volume endocrine surgery center from March 2018 to March 2024. A total of 537 consecutive patients with differentiated thyroid carcinoma underwent robotic BABA thyroidectomy with central neck dissection. Intraoperative refinements included real-time recurrent laryngeal nerve (RLN) monitoring, intraoperative parathyroid-hormone (PTH) testing, and nanocarbon lymph node mapping. Learning phases were defined by cumulative sum analysis. Primary outcomes were intraoperative RLN adverse events and inadvertent parathyroidectomy; secondary outcomes included operative time, lymph node yield, PTH recovery, complication rates, and tracheal injury. Among 537 patients (401 women, 74.7%; median age 43years), operative time decreased from 189.9 to 129.3min (P < 0.001), with plateaus at 152 and 352 cases. RLN adverse events declined from 16.7% (95% CI 7.9-30.2%) to 1.6% (95% CI 0.3-4.8%), and inadvertent parathyroidectomy decreased from 23.8% (95% CI 12.0-39.5%) to 1.6% (95% CI 0.3-4.8%). Six-month PTH levels improved from 3.15 to 4.14pmol/L, and lymph node yield increased from 9.9 to 13.3 (P = 0.019). Three patients (0.6%) developed tracheal fistula. Robotic BABA thyroidectomy demonstrates a structured learning curve in which functional safety improves with surgical experience and intraoperative standardization. These data-driven milestones may inform structured training and credentialing frameworks for robotic thyroid surgery.

Traumatic injuries can lead to systemic bone loss. While spinal cord injury (SCI)-related bone loss is well studied, the effects of TBI, burns, and fractures on bone metabolism remain less clear. This review examines post-traumatic bone loss across different injuries to guide future research, preventive, and treatment strategies. We conducted a systematic review according to PRISMA guidelines. PubMed, Web of Science, Scopus, and Science Direct were searched up to January 2025 using MeSH terms and keyword combinations related to traumatic injuries and bone loss. Studies were screened based on pre-defined inclusion and exclusion criteria, and relevant clinical and preclinical data were extracted and synthesized. The review included a total of 165 studies, including 5 clinical and 9 preclinical TBI studies, 73 clinical and 39 preclinical SCI studies, 16 clinical and 6 preclinical burn studies, and 10 clinical and 45 preclinical fracture studies. SCI can cause up to 50% BMD reduction within weeks, while burns lead to up to 8% BMD loss within two months, with osteoporosis affecting 10 to 50% of patients. TBI is linked to increased osteopenia and osteoporosis, and fractures result in BMD changes of 5 to 28% in the injured limb, along with a higher risk of subsequent fractures on either side. Preclinical studies confirmed impaired bone quality, increased resorption, and decreased formation across injury types. The potential mechanisms contributing to post-traumatic bone loss include mechanical unloading with increased sclerostin signaling, systemic inflammation driving osteoclastogenesis, nervous system dysregulation changing neuroosteogenic interaction, nutritional and metabolic imbalances, and hormonal disturbances involving parathyroid hormone, growth hormone, and cortisol. Post-traumatic bone loss presents a distinct etiology, resulting from an interaction of mechanical, inflammatory, neural, nutritional, and hormonal factors. Recognizing these mechanisms is essential for developing targeted interventions to prevent bone deterioration, reduce fracture risk, and improve long-term patient outcomes after trauma.

BackgroundIn older adults, hospitalization often leads to increased frailty, which can result in higher rates of subsequent hospitalization and mortality. This study investigated whether a history of hospitalization before initiating dialysis affected mortality rates in dialysis patients.MethodsWe analyzed 2,765 patients who visited hemodialysis clinics at 17 teaching hospitals. The study examined the association between mortality and various factors, including demographics, comorbidities, laboratory findings, and medication use. Hazard ratios (HR) were calculated using survival analysis to determine whether prior hospitalization increased mortality risk in dialysis patients.ResultsOf the subjects, 8.0% (n = 222) had been hospitalized for 1 month or longer within the year before starting dialysis. There was no significant difference in gender between the two groups; however, the hospitalized group was older, and many patients in this group began dialysis using a catheter. This group also had a higher prevalence of conditions such as cerebrovascular accidents (CVA), hypertension, dementia, heart failure, and atrial fibrillation. Laboratory findings revealed higher platelet counts and blood urea nitrogen (BUN) levels, but lower levels of intact parathyroid hormone, creatinine, albumin, alkaline phosphatase, and cholesterol. Additionally, this group used fewer medications, including renin-angiotensin-aldosterone system blockers, calcium channel blockers, and antiplatelet agents. In multivariate analysis, controlling for factors such as age, sex, dialysis access, comorbidities (e.g., dementia, malignancy, ischemic heart disease, CVA, heart failure, atrial fibrillation, liver cirrhosis, fractures), ejection fraction, and laboratory markers (e.g., lymphocytes, platelets, BUN, creatinine, albumin, phosphorus, total cholesterol), the HR for mortality in the group with a history of hospitalization was 1.686 (95% CI, 1.162–2.447).ConclusionsPatients hospitalized for more than 1 month before starting dialysis had significantly higher overall mortality rates. These findings highlight the need for comprehensive care and targeted interventions for this high-risk population.Clinical trial numberNot applicable.

Tertiary hyperparathyroidism (THPT) arises in patients with chronic kidney disease (CKD) as a consequence of prolonged secondary hyperparathyroidism and is marked by autonomous parathyroid hormone (PTH) secretion. In some cases, parathyroid hyperplasia persists even after successful renal transplantation, resulting in sustained PTH elevation and hypercalcaemia. These alterations contribute to bone loss, vascular calcification, and increased cardiovascular risk. Management includes medical therapy with calcimimetics or vitamin D analogues and surgical intervention via parathyroidectomy. However, optimal timing and treatment strategy remain uncertain. This review examines the pathophysiology, clinical manifestations, and current management paradigms of THPT, with an emphasis on areas that require further research and consensus.

Preclinical studies demonstrate that treatment with calcitriol attenuates skeletal complications in mice with X-linked hypophosphatemia (XLH). To assess serum markers of mineral metabolism, nephrocalcinosis, skeletal microarchitecture, growth, and evidence of rickets following calcitriol monotherapy in children and adults with XLH. A 1-year prospective single-arm open-label study comparing baseline and 12-month outcomes. Participants were recruited from outpatient endocrinology clinics in the United States. Data were collected in a research unit. Eligible participants were ≥ 4 years old, not pregnant, with baseline 25-hydroxyvitamin D ≥20 ng/mL and normal serum calcium. Participants were treated with calcitriol, with dose based on serum and urinary calcium concentrations, for 1 year. The primary endpoints were change in serum phosphate and nephrocalcinosis (all participants) and rickets severity score (children). Secondary endpoints included changes in additional markers of mineral metabolism, skeletal microarchitecture parameters via high-resolution peripheral quantitative computed tomography (all participants), and height z-scores (children). Serum phosphate did not change over 12 months of optimized calcitriol treatment. Rickets improved in 2 of 4 children with open epiphyses; height z-scores were unchanged. Nephrocalcinosis scores remained stable. Adults had increased cortical thickness at the radius diaphysis (p=0.012). Serum alkaline phosphatase decreased in children (p=0.021) and parathyroid hormone trended lower in both children (p=0.065) and adults (p=0.063). 4 participants developed mild hypercalcemia and 2 developed hypercalciuria which resolved with calcitriol titration. Calcitriol monotherapy is safe and well-tolerated in XLH, with modest benefits on laboratory indices of mineral metabolism and rickets.

Allosteric modulation of Class B1 G protein-coupled receptor activation and signaling location in the cell.

The study objective was to determine the value contribution of palopegteriparatide to the treatment of adults with chronic hypoparathyroidism, a rare endocrine disease, through a multi-criteria decision analysis (MCDA). The Orphar-SEFH group framework for evaluating orphan drugs was used, along with the weighting performed by 98 national and regional evaluators. A multidisciplinary panel of seven experts individually scored the evidence matrix. The scores were collected and analysed using Microsoft Excel software programmed for MCDA study analysis. The results were discussed in a reflective discussion session. The expert panel considered chronic hypoparathyroidism to be a moderate-to-severe disease (mean ± SD: 3.3 ± 0.5) due to its multiorgan impact and associated comorbidities, with significant unmet needs (3.6 ± 1.0), particularly related to the lack of the physiological effect due to insufficient levels of parathyroid hormone. The experts found palopegteriparatide as an add-on treatment to conventional therapy (calcium and active vitamin D) to be much more effective than placebo plus conventional therapy, with this criterion receiving the highest score. The safety profile was considered acceptable (1.6 ± 1.1). The participants highlighted the positive impact of palopegteriparatide on patient-reported outcomes (2.9 ± 0.9) compared to placebo because of improvements in quality of life (QoL). Palopegteriparatide was seen as a potentially disease-modifying treatment, which could lead to savings in "other medical costs" (3.1 ± 1.1) and "non-medical/indirect costs" (2.0 ± 0.8), although no evidence was available, especially in the long term. The quality of the evidence was perceived as high (3.6 ± 0.5). The overall value contribution of palopegteriparatide was 0.58 (+ 1 = maximum value) compared to placebo. The study has some limitations, including a relatively small panel size and the exclusion of treatment cost as a criterion due to lack of pricing information at the time of evaluation. According to MCDA, palopegteriparatide represents a valuable therapeutic option for chronic hypoparathyroidism treatment, particularly due to its demonstrated efficacy, which had an impact on patients' QoL, and the current unmet needs in this therapeutic area.

Fluorescent Imaging in Thyroid Surgery to Preserve Parathyroid Function: A Systematic Review and Meta-Analysis.