Biochemical and clinical outcomes of once-daily teriparatide in refractory chronic hypoparathyroidism: A single-center experience

Objectives: Chronic hypoparathyroidism causes disrupted calcium-phosphate balance due to parathyroid hormone (PTH) deficiency. In refractory disease, recombinant PTH (1–34) (teriparatide) can support conventional therapy. This study assessed short-term biochemical and clinical outcomes under real-word of once-daily teriparatide in refractory hypoparathyroidism.
Materials and Methods: Ten patients with chronic hypoparathyroidism who received subcutaneous teriparatide (20 µg/day) between January 2021 and September 2025 were retrospectively analyzed. The median duration of teriparatide therapy was 9 months (interquartile range: 4–22), with a maximum of 27 months. Clinical records, biochemical parameters, and calcium/vitamin D supplementation requirements were systematically reviewed.
Results: Albumin-corrected calcium increased significantly at 3 months (median 7.79 vs. 6.5 mg/dL, p=0.038) but not at 6 months (p>0.05). Phosphorus decreased at 3 months (p=0.012) with a non-significant trend thereafter (p=0.06). No correlation was observed between calcium change and treatment duration (ρ=–0.8, p=0.2). All patients reported symptomatic relief and reduced intravenous calcium requirements, though complete independence was not achieved.
Conclusion: Once-daily teriparatide provided transient biochemical improvement and clinical relief in refractory hypoparathyroidism but was insufficient to maintain sustained normocalcemia, suggesting possible pharmacological limitations of once-daily intermittent PTH replacement that warrant further investigation in larger prospective studies. Individualized treatment duration, alternative dosing regimens, and longer-term controlled studies are warranted to optimize therapeutic outcomes.

Keywords: Hypocalcemia, Hypoparathyroidism, Parathyroid hormone, Teriparatide