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

Yamamoto, Junya; Nakazawa, Daigo; Nishio, S.; Ishikawa, Yasunobu; Makita, Minoru; Kusunoki, Yoshihiro; Nagai, So; Fujieda, Yuichiro; Takahata, Masahiko; Yamane, Kanji; Yamamura, Tsuyoshi; Yotsukura, Akihiko; Saito, Masanobu; Shimazaki, M; Atsumi, Tatsuya

doi:10.1111/1744-9987.12867

Cited by 24 publications

(14 citation statements)

References 15 publications

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“…[39][40][41] Furthermore, teriparatide has been shown to be effective in short-term administrations, with fusion mass acceleration being demonstrated with treatment durations as short as 8 weeks. 13,42,43 However, the results of our meta-analyses demonstrate that teriparatide has limited benefit in improving secondary outcomes such as postoperative pain and disability. Larger prospective trials are still needed to elucidate the true effect on clinical outcomes.…”

Section: Bone Qualitymentioning

confidence: 83%

Osteoporosis treatment in patients undergoing spinal fusion: a systematic review and meta-analysis

Govindarajan

Diaz

Perez-Roman

et al. 2021

Neurosurgical Focus

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OBJECTIVE Bisphosphonates and teriparatide are the most common therapies used in the treatment of osteoporosis. Their impact on fusion rates in osteoporotic patients following spinal fusion has yet to be concretely defined, with previous systematic reviews focusing heavily on bisphosphonates and lacking clinical insight on the utility of teriparatide. Herein the authors present an updated meta-analysis of the utility of both bisphosphonates and teriparatide in improving spinal fusion outcomes in osteoporotic patients. METHODS After a comprehensive search of the English-language literature in the PubMed and Embase databases, 11 clinical studies were included in the final qualitative and quantitative analyses. Of these studies, 9 investigated bisphosphonates, 7 investigated teriparatide, and 1 investigated a combination of teriparatide and denosumab. Odds ratios and 95% confidence intervals were calculated where appropriate. RESULTS A meta-analysis of the postoperative use of bisphosphonate demonstrated better odds of successful fusion as compared to that in controls during short-term monitoring (OR 3.33, 95% CI 1.72–6.42, p = 0.0003) but not long-term monitoring (p > 0.05). Bisphosphonate use was also shown to significantly reduce the likelihood of postoperative vertebral compression fracture (VCF; OR 0.07, 95% CI 0.01–0.59, p = 0.01) and significantly reduce Oswestry Disability Index scores (mean difference [MD] = −2.19, 95% CI −2.94 to −1.44, p < 0.00001) and visual analog scale pain scores (MD = −0.58, 95% CI −0.79 to −0.38, p < 0.00001). Teriparatide was found to significantly increase fusion rates at long-term postoperative periods as compared to rates after bisphosphonate therapy, with patients who received postoperative teriparatide therapy 2.05 times more likely to experience successful fusion (OR 2.05, 95% CI 1.17–3.59, p = 0.01). CONCLUSIONS The authors demonstrate the benefits of bisphosphonate and teriparatide therapy independently in accelerating fusion during the first 6 months after spinal fusion surgery in osteoporotic patients. In addition, they show that teriparatide may have superior benefits in spinal fusion during long-term monitoring as compared to those with bisphosphonates. Bisphosphonates may be better suited in preventing VCFs postoperatively in addition to minimizing postoperative disability and pain.

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Section: Bone Qualitymentioning

confidence: 83%

Osteoporosis treatment in patients undergoing spinal fusion: a systematic review and meta-analysis

Govindarajan

Diaz

Perez-Roman

et al. 2021

Neurosurgical Focus

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“…[64] Intermittent administration of PTH increased bone formation and bone turnover and trabecular bone mass. [65] In experimental renal failure, intermittent administration of PTH (1-34) protects against bone demineralization and vascular calcification. In an animal model with established advanced CKD following 5/6 nephrectomy, the intermittent administration of PTH (1-34) increased bone formation and expression of renal but not bone PTH1R mRNA, while decreasing vascular calcification.…”

Section: Ca Retention In the Genesis Of Ckd-mbd: A Factor We Ignored mentioning

confidence: 99%

Current Understanding of Mineral and Bone Disorders of Chronic Kidney Disease and the Scientific Grounds on the Use of Exogenous Parathyroid Hormone in Its Management

Pazianas

Miller

2020

J Bone Metab

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Chronic Kidney disease (CKD) disturbs mineral homeostasis leading to mineral and bone disorders (MBD). Serum calcium and phosphate (Pi) remain normal until the late stages of CKD at the expense of elevate fibroblast growth factor-23 (FGF-23), a phosphaturic hormone, followed by reduced 1,25-dihydroxy-vitamin D (1,25[OH]2D) and finally elevated parathyroid hormone (PTH). Pi retention is thought to be the initial cause of CKD-MBD. The management of MBD is a huge clinical challenge because the effectiveness of current therapeutic regimens to prevent and treat MBD is limited. An intermittent regimen of PTH, when administered at the early stages of CKD, through its phosphaturic action, could prevent FGF-23 increases, the drop of 1,25(OH)2D, and the development of renal osteodystrophy, including secondary hyperparathyroidism (HPT) and its catabolic effects on the skeleton. Even in more advanced stages of CKD that have not progressed to tertiary HPT, could be beneficial. Therapeutic effects could be achieved in vascular calcification as well. Limited experimental/clinical data support the effectiveness of PTH in CKD-MBD. Its safety, has been established only when it is used for the treatment of osteoporosis, including patients with CKD. The proposed intermittent PTH administration is biologically plausible but its effectiveness and safety has to be critically assessed in long term prospective studies in patients with CKD-MBD.

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“…Teriparatide can potentially have beneficial effects in CKD patients with LTBD. Teriparatide improved lumbar spine BMD, but its impact on femoral neck BMD was inconsistent in both HD and earlier stages of CKD patients [ 87 , 109 , 110 ]. Teriparatide improved bone formation, confirmed by bone biopsy, in an HD patient with LTBD [ 111 ].…”

Section: Pharmacological Approachmentioning

confidence: 99%

Bone Quality in Chronic Kidney Disease Patients: Current Concepts and Future Directions – Part II

et al. 2021

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Background: Patients with chronic kidney disease (CKD) have an increased risk of osteoporotic fractures, which is due not only to low bone volume and mass but also poor microarchitecture and tissue quality. The pharmacological and nonpharmacological interventions detailed, herein, are potential approaches to improve bone health in CKD patients. Various medications build up bone mass but also affect bone tissue quality. Antiresorptive therapies strikingly reduce bone turnover; however, they can impair bone mineralization and negatively affect the ability to repair bone microdamage and cause an increase in bone brittleness. On the other hand, some osteoporosis therapies may cause a redistribution of bone structure that may improve bone strength without noticeable effect on BMD. This may explain why some drugs can affect fracture risk disproportionately to changes in BMD. Summary: An accurate detection of the underlying bone abnormalities in CKD patients, including bone quantity and quality abnormalities, helps in institution of appropriate management strategies. Here in this part II, we are focusing on advancements in bone therapeutics that are anticipated to improve bone health and decrease mortality in CKD patients. Key Messages: Therapeutic interventions to improve bone health can potentially advance life span. Emphasis should be given to the impact of various therapeutic interventions on bone quality.

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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

Cited by 24 publications

References 15 publications

Osteoporosis treatment in patients undergoing spinal fusion: a systematic review and meta-analysis

Osteoporosis treatment in patients undergoing spinal fusion: a systematic review and meta-analysis

Current Understanding of Mineral and Bone Disorders of Chronic Kidney Disease and the Scientific Grounds on the Use of Exogenous Parathyroid Hormone in Its Management

Bone Quality in Chronic Kidney Disease Patients: Current Concepts and Future Directions – Part II

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