During recent years, it has become apparent that chronic hypoparathyroidism (hypoPT) is a complex disease characterized by the deficiency of parathyroid hormone (PTH) and as a consequence calcitriol [1, 25 (OH) 2 vitamine D]. Besides hypocalcemia, hypoPT is associated with additional biochemical disturbances, such as hyperphosphatemia and hypercalciuria. Moreover, patients suffer from impaired quality of life (QoL) and an increased risk of various co-morbidities. These include renal impairment, stones and/or nephrocalcinosis, impaired bone quality, neuropsychiatric diseases, infections and an increased mortality. Lately, different hypoparathyroidism-specific tailored instruments were developed to assess the nature and the degree of symptoms or complaints in hypoPT patients. These instruments highlighted differences compared to control groups as well as a correlation to laboratory values, especially the calcium-phosphate product. In addition to growing insights into its clinical consequences, in recent years recombinant human parathyroid hormone (1-84) [rhPTH (1-84)] has become available as a replacement of the missing hormone. Data demonstrating efficacy and safety of rhPTH (1-84) in both short-term and long-term studies are now available. Long-term administration of rhPTH (1-84) resulted in sustained, and in some cases, progressive reductions in supplemental calcium and calcitriol requirements. With regard to bone structure, rhPTH (1-84) led to an increase in bone turnover in both the trabecular and cortical compartment and to a restoration of bone metabolism towards a euparathyroid state. Studies that have attempted to quantify QoL in hypoPT with widely used questionnaires such as the Short-Form-36 (SF-36) have revealed large deviations from the general population and improvement during long-term hormone replacement. However, evidence of improvement of QoL with rhPTH (1-84) when compared to placebo-treated control groups is still lacking. Moreover, hypercalciuria is reduced by treatment with rhPTH (1-84) only after the seventh year of treatment. Currently, a number of other treatment options are being developed offering physicians and patients a wider set of therapeutic options in the future.