Real-world management of hypoparathyroidism: the impact of endocrinology specialist follow-up on biochemical and clinical outcomes - a retrospective cohort study.

backgroundHypoparathyroidism is a chronic endocrine disorder requiring lifelong management, with real-world data on the impact of follow-up setting on biochemical and clinical outcomes remaining limited. This study aimed to evaluate real-world management of hypoparathyroidism and to investigate whether endocrinology specialist follow-up is associated with improved biochemical control and clinical outcomes.

methodsThis retrospective, single-center study included 186 patients with hypoparathyroidism categorized by follow-up setting (endocrinology vs. non-endocrinology clinics). Demographic, biochemical, and clinical data were collected. The primary outcome was achievement of target serum calcium levels (lower-normal or slightly below-normal range per current guidelines). Multivariate logistic regression was performed to identify independent predictors of target calcium achievement, adjusted for age, sex, eGFR, PTH, treatment doses, and serum 25(OH)D.

resultsThe mean age of the cohort was 49.5 ± 12.0 years, 78.5% were female and 82.3% had postsurgical hypoparathyroidism. Overall, 76.3% of patients achieved target serum calcium levels; while target phosphate and 25(OH)D levels were achieved in only 45.2% and 46.9%, respectively.Patients followed by endocrinology specialists demonstrated significantly higher rates of target calcium (96.3% vs. 60.6%, p<0.001), phosphate (53.7% vs. 38.5%, p=0.039), and 25(OH)D achievement (57.3% vs. 29.2%, p=0.002) compared with those followed in non-endocrinology settings. Daily calcium supplementation and calcitriol doses were comparable between groups. Guideline-recommended monitoring, including 24-hour urinary calcium and serum 25(OH)D assessment, as well as complication screening, was performed significantly more frequently in the endocrinology group (all p<0.001). In multivariate analysis, non-endocrinology follow-up was independently associated with lower odds of target calcium achievement (OR: 0.08, 95% CI: 0.02-0.33, p<0.001), while serum 25(OH) D was a positive predictor of target calcium achievement (OR: 1.12, 95% CI: 1.01-1.23, p=0.030). The model demonstrated adequate goodness-of-fit (Hosmer-Lemeshow p=0.127).

conclusionsFollow-up by endocrinology specialists is independently associated with improved biochemical control in patients with hypoparathyroidism, an effect not explained by differences in medication doses. These findings suggest that specialist follow-up may play an important role in optimizing biochemical target achievement and long-term disease management and support the integration of endocrinology specialist care as a standard component of routine clinical practice in hypoparathyroidism.