Teriparatide Treatment for Hypercalcemia Associated With Adynamic Bone Disease

Abstract

Hypercalcemia most often results from primary hyperparathyroidism and malignancy. Adynamic bone disease (ABD) is a form of renal osteodystrophy characterized by reduced bone turnover, which can limit the ability of bone to release or store calcium, potentially leading to low, normal, or high serum calcium levels. We describe a 51‐year‐old dialysis‐dependent female with hypercalcemia after parathyroidectomy. A demeclocycline‐labeled bone biopsy confirmed adynamic bone disease. Teriparatide, a recombinant form of parathyroid hormone (PTH) used to treat postmenopausal osteoporosis, was prescribed for 12 months and normalized serum calcium levels. Although previous case reports and series have described favorable changes in spine bone mineral density when teriparatide was prescribed for ABD, ours is the first documented case in which teriparatide resolved hypercalcemia due to ABD. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

Ganoderma lucidum Immune Modulator Protein rLZ-8 Could Prevent and Reverse Bone Loss in Glucocorticoids-Induced Osteoporosis Rat Model

“…Currently, the most widely used anti-osteoporosis medications are anti-resorptive drugs, such as bisphosphonates (alendronate, risedronate, zoledronate, and ibandronate) and RANKL antibodies which are largely limited by the adverse events in high risk of gastrointestinal disturbance and infection respectively (Lorentzon, 2019). Recently, two novel anabolic drugs improving bone formation, teriparatide and romosozumab, which are recombinant human parathyroid hormone and sclerostin monoclonal antibody respectively, provide promising options for osteoporosis treatment with side effects in high risk of transient or persistent hypercalcemia and stroke (Saag et al, 2017;Peugh et al, 2019). Therefore, exploring effective agents from natural products with minimal side effects is one of the promising alternative strategies (An et al, 2016).…”

Treatment of Severe Tumoral Calcinosis with Teriparatide in a Dialysis Patient after Total Parathyroidectomy

“…In retrospect, bone metabolism markers and measurement of bone density would have been informative of status of bone turnover, but these were not available at our centre. Our decision to embark on teriparatide therapy was based on a recent report of its use in the treatment of hypercalcemia associated with ABD [ 12 ]. There was clinically significant regression of tumoral calcinosis after teriparatide therapy.…”

Vitamin D and the Kidney: Two Players, One Console

“…Osteoporosis is defined as a systemic, skeletal disorder, where bone strength and resistance are compromised, and thus, affected patients have an elevated risk of fracture due to reduction in bone mass density (BMD, mineral quantity per square centimeter, expressed as g/cm 2 ) and bone quality (BQ, comprehensive of microarchitecture, mineralization, turnover, and microcrack accumulation) [ 23 , 24 , 25 , 26 , 27 , 28 ]. According to the World Health Organization (WHO), “osteoporosis is defined as a BMD that lies 2.5 standard deviations or more below the average value for young healthy women (a T-score of < −2.5 SD)”.…”

“…Conversely, in adynamic bone disease, low bone turnover is common, due to reduced osteoblasts and osteoclasts activity. The ability of bone to release or store calcium is consequently compromised, resulting in broad oscillation of calcium levels [ 24 , 25 ].…”