Parathyroids, bone and mineral metabolism

Purpose of reviewThe importance of parathyroid hormone in maintaining bone health has long been appreciated. Recent advances in the understanding of the cellular and molecular actions of this hormone have enhanced our treatment of parathyroid disorders and osteoporosis. Recent findingsParathyroid hormone has been shown to act at the cellular level through the activation of the RANK ligand system, which is a new target for drug development for osteoporosis. Our understanding of the natural history of primary hyperparathyroidism and the potential for medical management has recently come under greater scrutiny. An increased recognition of vitamin D inadequacy is changing our understanding of secondary hyperparathyroidism. Newer calcimimetic drugs are enhancing our therapy of both primary and secondary hyperparathyroidism. Synthetic parathyroid hormone has been shown to be both safe and effective in the treatment of osteoporosis. SummarySynthetic parathyroid hormone, the first anabolic agent for osteoporosis, has changed the therapeutic approach in severe osteoporosis. Although newer drugs have been used for primary hyperparathyroidism, surgery remains the definitive therapy. Increased understanding of the molecular biology of parathyroid hormone has allowed the development of new classes of therapeutic agents for osteoporosis.