Impact of Long-Term Cinacalcet, Ibandronate or Teriparatide Therapy on Bone Mineral Density of Hemodialysis Patients: A Pilot Study

Abstract

Background: Insufficient evidenced-based information is available for the treatment of osteoporosis in hemodialysis (HD) patients. Methods: In 102 HD patients, bone mineral density (BMD) was measured twice 16 ± 3 months apart. In the second BMD measurement 66 of them had a femoral neck (FN) T-score <–2.5. Of these 66 patients, 38 consented to a bone biopsy. Depending on both the bone biopsy findings and parathyroid hormone levels, patients were assigned to treatment groups. Eleven patients with osteitis fibrosa and iPTH >300 pg/ml received cinacalcet, 11 with osteitis fibrosa and iPTH <300 pg/ml received ibandronate, 9 with adynamic bone disease received teriparatide, and 7 with mild abnormalities received no treatment. A third BMD measurement was done after an average treatment period of 13–16 months. We compared the annual percent change of FN and lumbar spine (LS) BMD before and during treatment. Results: FN and LS BMD decreased significantly in the cinacalcet group, with an annual change of 3.6 and 3.4% before treatment to –4.2% (p = 0.04) and –7.7% (p = 0.02) during treatment, respectively. In the teriparatide group, FN and LS BMD increased, although not significantly, with an annual change of –5.4 and –2.6% before treatment to 2.7 and 4.9% during treatment, respectively. In both the ibandronate and the no treatment groups, BMD change rate remained negative during the whole study. Conclusions: Teriparatide administration improved BMD in HD patients with adynamic bone disease, although these results did not reach statistical significance. In HD patients with osteitis fibrosa, ibandronate did not improve BMD while cinacalcet reduced BMD.

Teriparatide and Bone Turnover and Formation in a Hemodialysis Patient With Low-Turnover Bone Disease: A Case Report

“…The investigators reported non-statistically significant increases in BMD, by 2.7% at the femoral neck and 4.9% at the lumbar spine. 4 Of note, we did not observe an increase in lumbar spine BMD, which contrasts with other reports.…”

“…3 The use of this agent in CKD is limited to 3 small studies, none of which report the effects of teriparatide on bone histomorphometry. [4][5][6] We report on bone mineral density (BMD) and bone histomorphometric responses in a dialysis-dependent patient with stage 5 CKD and low-turnover bone disease treated with teriparatide. …”

Osteoporosis and Impaired Trabecular Bone Score in Hemodialysis Patients

“…Although the treatment of osteoporosis in this population is not routinely recommended [7], some smaller studies have already proved the efficacy of various antiosteoporotic agents, e.g. bisphosphonates, denosumab, raloxifene or teriparatide [24][25][26][27]. Bone turnover assessed by biochemical markers on one side represents a key parameter for determining the best treatment strategy and on the other side could be used as an alternative to histomorphometric evaluation since this examination is commonly available.…”

Teriparatide treatment in a heart transplant patient with a chronic kidney disease and a low-turnover bone disease: a case report

“…Likely, a chronic steroid therapy and a low-turnover CKD-MBD accounted for a delayed response to TPTD, and the excessive response of bone formation in this patient reflects the early predominately anabolic effect [27]. In CKD patients with a low-turnover bone disease, TPTD seems to increase BMD [15, 28], but the data on histomorphometric response are limited to one case [16] . With denosumab, a treatment option for patients with normal- to high-turnover CMD, MBD has become available [12], but again histomorphometric data in CKD patients are lacking.…”