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We have now studied skeletal microstructure by high-resolution peripheral quantitative computed tomography (HR-pQCT) through 4\u2009years of treatment with recombinant human PTH(1\u201384) (rhPTH[1\u201384]) in 33 patients with hypoparathyroidism (19 with postsurgical disease, 14 idiopathic). We calculated Z-scores for our cohort compared with previously published normative values. We report results at baseline and 1, 2, and 4\u2009years of continuous therapy with rhPTH(1\u201384). The majority of patients (62%) took rhPTH(1\u201384) 100\u2009\u03bcg every other day for the majority of the 4\u2009years. At 48\u2009months, areal bone density increased at the lumbar spine (+4.9%\u2009\u00b1\u20090.9%) and femoral neck (+2.4%\u2009\u00b1\u20090.9%), with declines at the total hip (\u22122.3%\u2009\u00b1\u20090.8%) and ultradistal radius (\u22122.1%\u2009\u00b1\u20090.7%) (p\u2009&amp;lt;\u2009.05 for all). By HR-pQCT, at the radius site, very similar to the ultradistal DXA site, total volumetric BMD declined from baseline but remained above normative values at 48\u2009months (Z-score\u2009+\u20090.56). Cortical volumetric BMD was lower than normative controls at baseline at the radius and tibia (Z-scores \u22121.28 and\u2009\u2212\u20091.69, respectively) and further declined at 48\u2009months (\u22122.13 and\u2009\u2212\u20092.56, respectively). Cortical porosity was higher than normative controls at baseline at the tibia (Z-score\u2009+\u20090.72) and increased through 48\u2009months of therapy at both sites (Z-scores +1.80 and\u2009+\u20091.40, respectively). Failure load declined from baseline at both the radius and tibia, although remained higher than normative controls at 48\u2009months (Z-scores +1.71 and\u2009+\u20091.17, respectively). This is the first report of noninvasive high-resolution imaging in a cohort of hypoparathyroid patients treated with any PTH therapy for this length of time. The results give insights into the effects of long-term rhPTH(1\u201384) in hypoparathyroidism. \u00a9 2020 American Society for Bone and Mineral Research.<\/jats:p>","DOI":"10.1002\/jbmr.4005","type":"journal-article","created":{"date-parts":[[2020,3,10]],"date-time":"2020-03-10T12:50:28Z","timestamp":1583844628000},"page":"1274-1281","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":25,"title":["Changes in Skeletal Microstructure Through Four Continuous Years of rhPTH(1\u201384) Therapy in Hypoparathyroidism"],"prefix":"10.1093","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3042-5336","authenticated-orcid":false,"given":"Natalie E","family":"Cusano","sequence":"first","affiliation":[{"name":"Department of Medicine, Division of Endocrinology Lenox Hill Hospital New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mishaela R","family":"Rubin","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, College of Physicians & Surgeons Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John M","family":"Williams","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, College of Physicians & Surgeons Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanchita","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, College of Physicians & Surgeons Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaia","family":"Tabacco","sequence":"additional","affiliation":[{"name":"Unit of Endocrinology and Diabetes, Department of Medicine University Campus Bio-Medico Rome Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donovan","family":"Tay","sequence":"additional","affiliation":[{"name":"Department of Medicine Sengkang General Hospital Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rukshana","family":"Majeed","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, College of Physicians & Surgeons Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beatriz","family":"Omeragic","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, College of Physicians & Surgeons Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John P","family":"Bilezikian","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Endocrinology, College of Physicians & Surgeons Columbia University New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2020,3,10]]},"reference":[{"issue":"2","key":"2024031418594126000_jbmr4005-bib-0001","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1016\/8756-3282(95)00443-2","article-title":"Bone histomorphometry in hypoparathyroid patients treated with vitamin D","volume":"18","author":"Langdahl","year":"1996","journal-title":"Bone."},{"issue":"12","key":"2024031418594126000_jbmr4005-bib-0002","doi-asserted-by":"crossref","first-page":"2018","DOI":"10.1359\/jbmr.080803","article-title":"Dynamic and structural properties of the skeleton in hypoparathyroidism","volume":"23","author":"Rubin","year":"2008","journal-title":"J Bone Miner Res."},{"issue":"11","key":"2024031418594126000_jbmr4005-bib-0003","doi-asserted-by":"crossref","first-page":"2727","DOI":"10.1002\/jbmr.452","article-title":"PTH(1-84) administration reverses abnormal bone-remodeling dynamics and structure in hypoparathyroidism","volume":"26","author":"Rubin","year":"2011","journal-title":"J Bone Miner Res."},{"issue":"4","key":"2024031418594126000_jbmr4005-bib-0004","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1056\/NEJMcp0803050","article-title":"Clinical practice. 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