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

Abstract

Purpose

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.

Methods

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 ≥ 2000 mg/day oral elemental calcium and who were admitted to emergency department or our outpatient clinic at least once in the last 3 months 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.

Results

Before alternate-day dosing regimen, median oral calcium intake was 3750 mg/day, oral calcitriol intake was 0.88 mcg/day, serum calcium levels were 7.71 mg/dL, serum phosphate levels were 5.35 mg/dL, and 24-h urine calcium levels were 165 mg/day. Following alternate-day dosing regimen, median oral calcium intake was 1500 mg/day, oral calcitriol intake was 0.88 mcg/day, serum calcium levels were 8.25 mg/dL, serum phosphate levels were 5 mg/dL, and 24-h urine calcium levels were 210.5 mg/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.

Conclusion

Patients with uncontrolled chronic hypoparathyroidism could be controlled more effectively with alternate-day dosing regimen.

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Correspondence to T. Akkan.

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On behalf of all authors, the corresponding author states that there is no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by Kecioren Clinical Research Ethics Committee (2012-KAEK-15/1811).

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Informed consent was obtained from all individual participants included in the study.

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Akkan, T., Dagdeviren, M., Koca, A.O. et al. Alternate-day calcium dosing may be an effective treatment option for chronic hypoparathyroidism. J Endocrinol Invest 43, 853–858 (2020). https://doi.org/10.1007/s40618-019-01173-9

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Keywords

  • Alternate-day dosing
  • Chronic hypoparathyroidism
  • Calcium
  • Emergency visits