Why do we not treat hypoparathyroidism with pth? is it orphan drug issue? the use of ca/vit d etc is clearly suboptimal.

Sometimes we do...: Forteo, which is the 1st 34 Amino Acids of human PTH is sometimes used to treat difficult to manage hypoparathyroidism (not controlled with ca/calcitriol ; hctz). Unfortunately, because it was developed for the tx of osteoporosis (where the $ is), there are no good studies for hypopara. It is also typically an expensive drug.

Not approved yet but: Even though a synthetic form of Parathyroid called Teriparatide has been approved by FDA for treatment of Severe Osteoporosis in men and women but it has not been approved for use in patients with Hypoparathyroidism. But I know it is being used off label by some Endocrinologists for treatment of secondary parathyroidism after parathyroid surgery and in some cases of Hypoparathyroidism.