Once-weekly teriparatide in hemodialysis patients with hypoparathyroidism and low bone mass: a prospective study

Sumida, Keiichi; Ubara, Yoshifumi; Hoshino, Junichi; Mise, Kazuyuki; Hayami, Noriko; Suwabe, Tatsuya; Kawada, Manabu; Imafuku, Aya; Hiramatsu, Rikako; Hasegawa, Eiko; Yamanouchi, Masayuki; Sawa, Naoki; Takaichi, Kennmei

doi:10.1007/s00198-015-3377-6

Cited by 53 publications

(41 citation statements)

References 38 publications

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“…Most patients in this study were diabetic, being consistent with past etiology of ABD. Our data indicated that weekly teriparatide positively influenced the bone metabolism of patients with low‐turnover bone or ABD from diabetes and other causes, and predominantly affected the trabecular bone, as was previously reported . Pharmacologically, weekly teriparatide in osteoporosis patients mainly activates osteoblasts leading to predominant bone formation .…”

Section: Discussionsupporting

confidence: 86%

“…These factors are supported by the transition of bone turnover markers and biochemical markers found in our data. Similar to a previous report , weekly teriparatide had frequent adverse effects specific for HD patients, including hypotension and malaise. Weekly teriparatide might induce vasodilation compared to daily agents due to the high dose of each administration .…”

Section: Discussionsupporting

confidence: 85%

“…The mechanism that weekly teriparatide induces endogenous PTH secretion might relate to the following factors: (i) bone turnover is activated and bone can spend the calcium during bone formation in response to teriparatide ; and (ii) the sensitivity of the calcium sensing receptors of the parathyroid is upregulated and can react to lowering calcium concentrations . These factors are supported by the transition of bone turnover markers and biochemical markers found in our data.…”

Section: Discussionsupporting

confidence: 67%

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Impact of Weekly Teriparatide on the Bone and Mineral Metabolism in Hemodialysis Patients With Relatively Low Serum Parathyroid Hormone: A Pilot Study

et al. 2019

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Adynamic bone disease in HD patients is characterized by skeletal resistance to parathyroid hormone (PTH) or suppression of PTH release, leading to a downregulated bone turnover and bone fracture. Hence, we examined the efficacy of weekly teriparatide for HD patients with low PTH indicating adynamic bone disease without a history of parathyroidectomy. Fifteen HD patients with low PTH were recruited in this prospective observational study. Of them, 10 received teriparatide for 12 months and five nontreated patients were enrolled as control. Primary outcomes were defined as the changes in bone mineral density and bone turnover markers. Bone mineral density at the lumbar spine increased by 3.7% and 2.5% at 6 and 12 months, respectively, and bone formation markers increased, while bone resorption markers did not change in the teriparatide group. At 12 months after teriparatide administration, endogenous PTH was secreted followed by the recovery of low bone turnover. 40% of patients in the teriparatide group dropped out due to adverse events and the most common adverse event was transient hypotension. This study suggests that weekly teriparatide for HD patients with low PTH in the absence of parathyroidectomy accelerates bone formation and bone turnover, leading to increased trabecular bone mass and secretion of endogenous PTH.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionsupporting

confidence: 85%

Section: Discussionsupporting

confidence: 67%

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Impact of Weekly Teriparatide on the Bone and Mineral Metabolism in Hemodialysis Patients With Relatively Low Serum Parathyroid Hormone: A Pilot Study

et al. 2019

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“…Although teriparatide should be used with caution in osteoporotic patients with CKD due to higher blood PTH level in secondary hyperparathyroidism associated with CKD, intermittent PTH administration can be used to induce an anabolic effect on bone in CKD. Some studies have reported that teriparatide treatment increases BMD [118–120] and ameliorates bone turnover [120]. Subjects of these studies showed decreased endogenous PTH concentration compared to appropriate controls.…”

Section: Pharmacological Therapeutics For Bone Fractures In Ckd Pamentioning

confidence: 99%

Molecular Abnormalities Underlying Bone Fragility in Chronic Kidney Disease

Iwasaki

Kazama

Fukagawa

2017

BioMed Research International

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Prevention of bone fractures is one goal of therapy for patients with chronic kidney disease-mineral and bone disorder (CKD-MBD), as indicated by the Kidney Disease: Improving Global Outcomes guidelines. CKD patients, including those on hemodialysis, are at higher risk for fractures and fracture-related death compared to people with normal kidney function. However, few clinicians focus on this issue as it is very difficult to estimate bone fragility. Additionally, uremia-related bone fragility has a more complicated pathological process compared to osteoporosis. There are many uremia-associated factors that contribute to bone fragility, including severe secondary hyperparathyroidism, skeletal resistance to parathyroid hormone, and bone mineralization disorders. Uremia also aggravates bone volume loss, disarranges microarchitecture, and increases the deterioration of material properties of bone through abnormal bone cells or excess oxidative stress. In this review, we outline the prevalence of fractures, the interaction of CKD-MBD with osteoporosis in CKD patients, and discuss possible factors that exacerbate the mechanical properties of bone.

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“…Also, we could not determine whether alternative treatment schedules (i.e. once per week; [22]) would have been more beneficial. It should be noted that occurrence of calciphylaxis has been reported during teriparatide treatment [23]; yet it is unknown if reduced or increased bone turnover was present in these patients.…”

Section: Discussionmentioning

confidence: 99%

A case report of severe calciphylaxis – suggested approach for diagnosis and treatment

et al. 2017

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Background: Calciphylaxis is a serious complication in patients with chronic kidney disease associated mineral and bone disorder. It can occur in conditions with low and high bone turnover. So far, there are no definite diagnostic and therapeutic guidelines which may prevent the devastating outcome in many calciphylaxis patients. We report a case which clearly illustrates that knowledge of the underlying bone disorder is essential for a directed treatment. Based on this experience we discuss a systematic diagnostic and therapeutic approach in patients with calciphylaxis. Case presentation: We report a patient with severe calciphylaxis. Initial evaluation showed an elevated serum parathormone concentration and a bone-specific alkaline phosphatase activity in the upper normal range; however, the bone biopsy clearly showed adynamic bone disease. Extended dialysis with low calcium dialysate concentration and citrate anticoagulation, and administration of teriparatide led to a further increase in bone-specific alkaline phosphatase activity and most importantly, resulted in an activated bone turnover as confirmed by a second bone biopsy 11 weeks later. Conclusions: This case illustrates that laboratory tests cannot reliably differentiate between high and low bone turnover in calciphylaxis patients. More importantly, this case highlights the fact that specific therapies that alter bone metabolism cannot be applied without knowledge of the bone status. On this background, we suggest that bone biopsies should be an integral part in the diagnosis and therapeutic decision in these patients and should be evaluated in further studies.

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Once-weekly teriparatide in hemodialysis patients with hypoparathyroidism and low bone mass: a prospective study

Abstract: Once-weekly teriparatide was associated with increased lumbar spine BMD in hemodialysis patients with hypoparathyroidism and low bone mass. Careful monitoring should be required for treatment of such patients.

Cited by 53 publications

References 38 publications

Impact of Weekly Teriparatide on the Bone and Mineral Metabolism in Hemodialysis Patients With Relatively Low Serum Parathyroid Hormone: A Pilot Study

Impact of Weekly Teriparatide on the Bone and Mineral Metabolism in Hemodialysis Patients With Relatively Low Serum Parathyroid Hormone: A Pilot Study

Molecular Abnormalities Underlying Bone Fragility in Chronic Kidney Disease

A case report of severe calciphylaxis – suggested approach for diagnosis and treatment

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