NATPARA^® is a parathyroid hormone indicated as an adjunct to calcium and vitamin D to control hypocalcemia in patients with hypoparathyroidism. Because of the potential risk of osteosarcoma, NATPARA is recommended only for patients who cannot be well-controlled on calcium supplements and active forms of vitamin D alone. NATPARA was not studied in patients with hypoparathyroidism caused by calcium-sensing receptor mutations. NATPARA was not studied in patients with acute post-surgical hypoparathyroidism.

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A diagnosis of hypoparathyroidism^a requires either
undetectable or inappropriately low levels of endogenous PTH^b
in the presence of hypocalcemia^2,c

Lab tests can confirm hypoparathyroidism and rule out other conditions.² Tests may include^2,3:

Serum total and ionized calcium levels
Intact PTH
Phosphorus/Phosphate
Magnesium

BUN/creatinine or eGFR (estimated glomerular filtration rate)
25-hydroxyvitamin D (25-OH
vitamin D)
24-hour urinary calcium

In hypoparathyroidism, concentrations of active vitamin D and bone turnover markers are typically in the low-normal to low range.²

Following neck surgery, chronic hypoparathyroidism is established only after 6 months.

By second- or third-generation immunoassay.

(Albumin-adjusted) confirmed on at least two occasions separated by at least 2 weeks.

A physical examination should include testing for Chvostek’s and Trousseau’s signs^2,3

Chvostek’s sign:

Tapping the patient's cheek over the path of the facial nerve causes twitching in the upper lip

Trousseau’s sign:

Inflating a blood pressure cuff on the patient's upper arm to a level above the systolic blood pressure for 3 minutes causes a painful carpal spasm

Neuromuscular irritability is the most common sign of hypocalcemia. Presentation depends on the severity and duration of hypocalcemia, and some patients may be asymptomatic

References: 1. NATPARA [package insert]. Shire Pharmaceuticals, Inc. 2. Brandi ML, Bilezikian JP, Shock D, et al. J Clin Endocrinol Metab. 2016;101(6):2273-2283. doi: 10.1210/jc.2015-3907. 3. Shoback D. N Engl J Med. 2008;359(4):391-403.

A diagnosis of hypoparathyroidisma requires either undetectable or inappropriately low levels of endogenous PTHb in the presence of hypocalcemia2,c

A physical examination should include testing for Chvostek’s and Trousseau’s signs2,3

Chvostek’s sign:

Trousseau’s sign:

A diagnosis of hypoparathyroidism^a requires either
undetectable or inappropriately low levels of endogenous PTH^b
in the presence of hypocalcemia^2,c

A physical examination should include testing for Chvostek’s and Trousseau’s signs^2,3