Title:Hypoparathyroidism: Musculoskeletal Manifestations Related to
Parathormone Deficiency
Volume: 20
Issue: 5
Author(s): Maroua Slouma*, Emna Hannech and Imen Gharsallah
Affiliation:
- Department of Rheumatology Military Hospital, El Manar University of Tunis, Tunis, Tunisia
- Faculty of Medicine of
Tunis, Tunis El Manar University, Tunisia
Keywords:
Arthritis, bone density, bone fractures, hypoparathyroidism, spondylarthritis, treatment.
Abstract:
Background: Hypoparathyroidism is a rare metabolic disorder that can be responsible
for musculoskeletal manifestations.
Aim: We present a systematic review of musculoskeletal manifestations of adult-onset nonsurgical
nongenetic hypoparathyroidism.
Methods: A systematic review was performed according to the Preferred Reporting Items for Systematic
Reviews and Meta-Analyses guideline using the MEDLINE database, including
manuscripts describing musculoskeletal manifestations of adult-onset nonsurgical nongenetic hypoparathyroidism.
Results: Musculoskeletal manifestations included myopathy, shoulder disorder, immune-negative
non-erosive peripheral arthritis, axial involvement simulating spondylarthritis, and diffuse ligamentous
ossifications. An association between hypoparathyroidism and spondyloarthritis or autoimmune
diseases is possible. T-cell activation, seen in patients with hypoparathyroidism, may
explain the co-occurrence of hypoparathyroidism with other autoimmune diseases.
The treatment of these manifestations is based on calcium and active vitamin D supplementation.
Parathyroid hormone may have an anabolic effect on muscle atrophy and muscle weakness.
Parathyroid hormone can also promote bone formation and bone resorption by stimulating osteoclast
differentiation by increasing RANKL (receptor activator for nuclear factor kappa-B ligand)
expression. Therefore, hypoparathyroidism can be responsible for an increase in bone mineral density.
However, the risk of fractures does not appear to be reduced due to changes in bone microarchitecture
and the high risk of falls. Treatment with parathyroid hormone has been shown to improve
bone microarchitecture.
Conclusion: Our review showed that musculoskeletal manifestations are frequent in patients with
hypoparathyroidism, including muscular, axial, peripheral articular, and entheseal manifestations.