A new study suggests that calcium supplements might not be necessary for all patients with hypoparathyroidism. This treatment approach could be especially helpful for patients dealing with calcium-related side effects.
The study, “Is calcium supplementation always needed in patients with hypoparathyroidism?” was published in Clinical Endocrinology.
Because hypoparathyroidism leads to low blood calcium levels, all major guidelines for how to treat it include having patients take calcium supplements. However, even with the best of treatment, it’s easy to over-correct and cause calcium levels to get too high. This can cause unpleasant side-effects, including diarrhea and kidney stones.
The investigators began by describing the case of a 56-year-old patient with a 10-year history of hypoparathyroidism (following total thyroidectomy for thyrotoxic Graves’ disease) who was referred to their clinic.
The patient’s original regimen consisted of calcium supplements and a vitamin D analog called alfacalcidol. Because calcium supplements caused stomach problems, clinicians reduced her dosage (from 1 gram three times a day to twice a day) and also gave her lansoprazole, which can help with stomach issues.
However, the lansoprazole caused the patient’s magnesium levels to drop too low, so the clinicians gave her further magnesium supplements. However, these caused diarrhea. Over the course of five years of treatment, the patient had to be hospitalized twice due to dangerously low calcium and magnesium levels, and she also was hospitalized once because her calcium levels were too high.
Due to this abundance of complications, the clinicians decided to move the patient to a regimen without the calcium supplementation. They switched her to a different combination of vitamin D analog and stomach-calming medication (colecalciferol and ranitidine, respectively) and advised her to gradually wean herself from the calcium supplement.
After two months of this treatment, the patient’s unpleasant side effects had all but gone, and her blood tests were within normal ranges. This was despite the patient having stopped taking anything except colecalciferol for two weeks earlier than what had been originally prescribed.
The investigators then examined records for 27 hypoparathyroidism patients – almost entirely White people from the UK and predominantly females – who were transferred to a treatment regimen without calcium. In the 24 patients who have completed this transition, calcium levels have been maintained stably, with no hospitalizations due to calcium-related problems.
The researchers also detail their experiences and provide general guidelines for this treatment strategy, with recommendations including ensuring sufficient vitamin D levels and which treatments they have found most effective for symptom management in particular cases.
The investigators then conducted a survey of more than 300 European patients treated for hypoparathyroidism. Although all of these patients were originally prescribed calcium supplements as part of their treatment, nearly a third no longer took them. Complaints about calcium supplement-related side effects, from constipation to kidney stones, were frequent.
Furthermore, only about half of those who stopped taking calcium supplements did so with their doctor’s advice, suggesting how unpleasant the side effects can be.
This study is still very preliminary, but the researchers suggest that more study into the best way to manage hypoparathyroidism could allow patients to remain healthy while avoiding unpleasant side-effects.
“It is feasible to consider a ‘no calcium’ regimen in selected [hypoparathyroidism] patients experiencing adverse effects from calcium supplements,” researchers concluded.