Teriparatide may accelerate the growth of a pre‑existing malignant tumor in an elderly patient with osteoporosis: A case report

Abstract

The present report describes a case in which teriparatide, which is widely used to treat osteoporosis, may have accelerated the growth of an undiagnosed pre-existing bone tumor of the femur. A 76-year-old woman visited hospital with pain in the right thigh after falling from a ladder. A non-pathological femoral shaft fracture was diagnosed by plain radiography. There were no findings of pathological fracture on the examination. In addition, the patient underwent intramedullary femoral nail fixation and started teriparatide treatment for osteoporosis. The teriparatide was discontinued after 2 months due to nausea. A total of 6 months after surgery, the woman visited Hirosaki University Hospital with abnormal swelling of the right thigh. Following a diagnosis of high-grade malignant mesenchymal bone tumor by needle biopsy, the patient underwent right hip disarticulation. Pathological examination provided a definitive diagnosis of osteoblastic osteosarcoma. The present case is a reminder that teriparatide may accelerate the growth of a pre-existing malignant tumor and that fractures, particularly in elderly patients, should be screened for pathological fracture prior to administering teriparatide.

Roles of Parathyroid Hormone-Related Protein (PTHrP) and Its Receptor (PTHR1) in Normal and Tumor Tissues: Focus on Their Roles in Osteosarcoma

“…This patient had no history of Paget's disease and had never received any radiotherapy. According to Ogawa et al (122), this case was the first case with definite correlation between teriparatide and acceleration of growth of a pre-existing malignant tumor in humans.…”

“…In addition, teriparatide is not used to treat patients affected by primary malignant and metastatic bone tumors ( 119 ), Paget's disease ( 120 ) or who have had radiotherapy ( 121 ). All these conditions may increase the probability of OS development in patient treated with teriparatide ( 122 ).…”

“…In humans, two cases of OS after treatment with teriparatide have been reported in the USA ( 122 ). Nevertheless, in the first case, the connection between teriparatide and the OS was not clear ( 121 ).…”

“…In the second case, the patient was treated with radiotherapy before treated with teriparatide; thus, it is uncertain whether the teriparatide treatment or radiotherapy was associated with development of OS ( 119 ). Recently, another patient developed OS after administration of teriparatide ( 122 ). This patient had no history of Paget's disease and had never received any radiotherapy.…”

‘Educated’ Osteoblasts Reduce Osteoclastogenesis in a Bone-Tumor Mimetic Microenvironment

“…Furthermore, teriparatide (sold under the brand name Forteo ® ) is a synthetic form of human parathyroid hormone that acts to promote bone density. However, some studies have suggested that teriparatide promotes osteosarcoma in rat models and may drive tumor progression in pre-malignant lesions in humans [ 19 ].…”