Effect of Teriparatide on Early Bone Loss After Kidney Transplantation

Cejka, Daniel; Benesch, Thomas; Krestan, Christian; Roschger, Paul; Klaushofer, Klaus; Pietschmann, Péter; Haas, Martin

doi:10.1111/j.1600-6143.2008.02327.x

Cited by 87 publications

(50 citation statements)

References 33 publications

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“…Recombinant parathyroid hormone (teriparatide) has also been evaluated recently 58. Its usefulness may be limited because of the secondary hyperparathyroidism commonly observed in long-term transplant recipients 46.…”

Section: Specific Types Of Osteoporosismentioning

confidence: 99%

Updated Recommendations for the Diagnosis and Management of Osteoporosis: A Local Perspective

Raef

Al-Bugami

Balharith

et al. 2011

Annals of Saudi Medicine

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Postmenopausal osteoporosis and osteoporosis in elderly men are major health problems, with a significant medical and economic burden. Although osteopenia and osteoporosis are more common locally than in the West, fracture rates are generally less than in Western countries. Vitamin D deficiency is common in the region and contributes adversely to bone health. Vitamin D deficiency should be suspected and treated in all subjects with ostopenia or osteoporosis. The use of risk factors to determine fracture risk has been adopted by the World Health Organization and many international societies. Absolute fracture risk methodology improves the use of resources by targeting subjects at higher risk of fractures for screening and management. The King Faisal Specialist Hospital Osteoporosis Working Group recommends screening for women 65 years and older and for men 70 years and older. Younger subjects with clinical risk factors and persons with clinical evidence of osteoporosis or diseases leading to osteoporosis should also be screened. These guidelines provide recommendations for treatment for postmenopausal women and men older than 50 years presenting with osteoporotic fractures for persons having osteoporosis—after excluding secondary causes—or for persons having low bone mass and a high risk for fracture. The Working Group has suggested an algorithm to use at King Faisal Specialist Hospital that is based on the availability, cost, and level of evidence of various therapeutic modalities. Adequate calcium and vitamin D supplement are recommended for all. Weekly alendronate (in the absence of contraindications) is recommended as first-line therapy. Alternatives to alendronate are raloxifene or strontium ranelate. Second-line therapies are zoledronic acid intravenously once yearly, when oral therapy is not feasible or complicated by side effects, or teriparatide in established osteoporosis with fractures.

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Section: Specific Types Of Osteoporosismentioning

confidence: 99%

Updated Recommendations for the Diagnosis and Management of Osteoporosis: A Local Perspective

Raef

Al-Bugami

Balharith

et al. 2011

Annals of Saudi Medicine

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show abstract

“…Alkaline phosphatase, osteocalcin, intact parathyroid hormone (iPTH), c-telopeptide pyridinoline crosslinks of type I collagen (CrossLaps), 25-hydroxycholecalciferol, calcitriol, calcium, and phosphate were quantified as described previously (15) according to Good Laboratory Practice standards.…”

Section: Serologic Parametersmentioning

confidence: 99%

Bone Microarchitecture in Hemodialysis Patients Assessed by HR-pQCT

Cejka

Patsch²,

Weber³

et al. 2011

Clinical Journal of the American Society of Nephrology

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SummaryBackground and objectives Dialysis patients are at high risk for low-trauma bone fracture. Bone density measurements using dual-energy x-ray absorptiometry (DXA) do not reliably differentiate between patients with and without fractures. The aim of this study was to identify differences in bone microarchitecture between patients with and without a history of fracture using high-resolution peripheral quantitative computed tomography (HR-pQCT).Design, setting, participants, & measurements Seventy-four prevalent hemodialysis patients were recruited for measurements of areal bone mineral density (aBMD) by DXA and bone microarchitecture by HR-pQCT. Patients with a history of trauma-related fracture were excluded. Forty healthy volunteers served as controls. Blood levels of parathyroid hormone, vitamin D, and markers of bone turnover were determined.Results Dialysis patients, particularly women, had markedly impaired bone microarchitecture. Patients with fractures had significantly reduced cortical and trabecular microarchitecture compared with patients without fractures. aBMD tended to be lower in patients with fractures, but differences were statistically not significant. The strongest determinant of fracture was the HR-pQCT-measured trabecular density of the tibia, which also had the highest discriminatory power to differentiate patients according to fracture status. Radial DXA had a lower discriminatory power than trabecular density. ConclusionsBone microarchitecture is severely impaired in dialysis patients and even more so in patients with a history of fracture. HR-pQCT can identify dialysis patients with a history of low-trauma fracture.

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“…A recent study of 26 kidney transplant recipients with daily teriparatide injections demonstrated a stabilization of BMD in the femoral neck and increased cortical width. But there was no improvement in bone turnover or bone mineralization as measured by histology (Cejka et al, 2008). Thus, its use in this setting remains experimental.…”

Section: Teriparatidementioning

confidence: 99%