burden of illness

Hypoparathyroidism and ongoing burden of illness

Patients with hypoparathyroidism (HPT) that is not adequately controlled can suffer from a high burden of illness.1

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Emergency room (ER)
visits and hospitalizations*

A retrospective chart review of 614 patients with HPT found that over a 1-year period2:

  • 41% had at least 1 ER visit. More ER visits were related to the management of hypoparathyroidism than related comorbidities.
  • 19.5% had at least 1 hospitalization. The majority of hospitalizations were due to hypoparathyroidism-related comorbidities.

Increased risk of comorbidities

Two separate analyses using a Danish patient registry found that patients with postsurgical HPT are at significantly increased risk of the following comorbidities, relative to the general population3-5:

COMORBIDITY CASES (n=688) CONTROLS
(n=2064)
HAZARD RATIO
(95% CI)
Renal insufficiency 35 21 3.10 (1.73-5.55)
Nephrolithiasis 13 8 4.02 (1.64-9.90)
Seizures 26 21 3.82 (2.15-6.79)
Neuropsychiatric disease 114 266 2.01 (1.16-3.50)
Infections 204 448 1.42 (1.20-1.67)

Hazard ratio indicates the relative risk of comorbidities developing at any time. CI, confidence interval.

Comorbidity observed

COMORBIDITY CASES
(n=688)
CONTROLS
(n=2064)
Renal insufficiency 35 21
Nephrolithiasis 13 8
Seizures 26 21
Neuropsychiatric disease 114 266
Infections 204 448

Risk of comorbidity in patients with hypoparathyroidism

Hazard ratio (HR) indicates the relative risk of comorbidities developing at any time.

COMORBIDITY HR (95% CI)
Renal insufficiency 3.10 (1.73-5.55)
Nephrolithiasis 4.02 (1.64-9.90)
Seizures 3.82 (2.15-6.79)
Neuropsychiatric disease 2.01 (1.16-3.50)
Infections 1.42 (1.20-1.67)

CI, confidence interval.

Impaired quality of life

Hypoparathyroidism may significantly impact patients’ quality of life. In addition to physical and emotional symptoms, many patients report an interference in their daily activities, employment, and personal relationships.1

In patients with hypoparathyroidism who self identified as not being adequately controlled§:

Impact

No Impact

§Not adequately controlled hypoparathyroidism was determined by persistent symptoms and/or poorly controlled calcium levels as determined by their physicians.

Evaluating for adequate control in HPT patients on conventional therapy requires monitoring not only of serum calcium, but also of serum phosphate, calcium-phosphate product, and urinary calcium. Symptoms, quality of life, and comorbidities must also be observed.6

BEYOND CALCIUM CONTROL

*Chen K et al. A retrospective, cross-sectional physician-administered chart review of 614 patients with hypoparathyroidism. Patients were evaluated over a 1-year period. The study evaluated hypoparathyroidism-related healthcare resource utilizations, symptoms, comorbidities, and laboratory values.1 A limitation of this study was selection bias as participating physicians selected eligible charts, and the sample may not have been representative of the overall HPT population.

†Underbjerg L et al (2013-2014). Two separate case-controlled studies in the same population of 688 patients with chronic postsurgical hypoparathyroidism and 2,064 age-matched controls from a Danish National Patient Registry. Patient cases were evaluated to assess cardiovascular disease, renal disease, psychiatric disease, infections, as well as many other complications.2,3 Limitations include the use of ICD codes to identify patients, which may have missed patients who were not treated in a hospital. The study may not have had sufficient size to detect low-incidence complications such as atypical fractures. Information on the use of bisphosphonates in the control group was not available. Also, patients with HPT are often followed-up at outpatient clinics at hospitals, which may lower the threshold for in-hospital treatment by another medical specialist.

‡Siggelkow H et al. A global patient and caregiver survey of 398 patients with hypoparathyroidism who self-identified as not adequately controlled with standard therapy and their caregivers. Health-related quality of life, health status, and hypoparathyroidism-associated symptoms were assessed to describe the overall burden of illness in hypoparathyroidism.5 Limitations of this study included selection bias due to non-responders and online recruiting may have led to selective sampling of more-affected patients.

REFERENCES:

1. Siggelkow H, Clarke BL, Germak J, et al. Burden of illness in not adequately controlled chronic hypoparathyroidism: findings from 13-country patient and caregiver survey. Clin Endocrinol (Oxf). 2020;92(2):159-168. 2. Chen K, Krasner A, Li N, Xiang CQ, Totev T, Xie J. Clinical burden and healthcare resource utilization among patients with chronic hypoparathyroidism, overall and by adequately vs not adequately controlled disease: a multi-country chart review. J Med Econ. 2019;22(11):1141-1152. 3. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. Cardiovascular and renal complications to postsurgical hypoparathyroidism: a Danish nationwide controlled historic follow-up study. J Bone Miner Res. 2013;28(11):2277-2285. 4. Underbjerg L, Sikjaer T, Mosekilde L, Rejnmark L. Postsurgical hypoparathyroidism—risk of fractures, psychiatric diseases, cancer, cataract, and infection. J Bone Miner Res. 2014;29(11):2504-2510. 5. Rejnmark L, Underbjerg L, Sikjaer T. Hypoparathyroidism: replacement therapy with parathyroid hormone. Endocrinol Metab (Seoul). 2015;30(4):436-442. 6. Brandi ML, Bilezikian JP, Shoback D, et al. Management of hypoparathyroidism: summary statement and guidelines. J Clin Endocrinol Metab. 2016;101(6):2273-2283