Treatment of adynamic bone disease in a haemodialysis patient with teriparatide

Giamalis, Panagiotis; Economidou, Dominiki; Dimitriadis, Chrysostomos; Memmos, Dimitrios; Papagianni, Αikaterini; Efstratiadis, Georgios

doi:10.1093/ckj/sfv005

Cited by 18 publications

(10 citation statements)

References 8 publications

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“…In patients with CKD G5D and biopsy proven adynamic bone disease, daily administration of teriparatide for 6 months resulted in lumbar spine and femoral neck BMD [ 169 ]. Increased bone turnover after using teriparatide has also been found in some CKD G5D cases [ 170 , 171 ]. In patients with CKD G5D with hypothyroidism and osteoporosis, administration of teriparatide once a week increased lumbar spine BMD, bone formation, and resorption markers [ 172 ].…”

Section: Management Of Chronic Kidney Disease-mineral and Bone Dismentioning

confidence: 99%

Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review

Hsu

Chen

2020

IJMS

103

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Chronic kidney disease (CKD) is associated with the development of mineral bone disorder (MBD), osteoporosis, and fragility fractures. Among CKD patients, adynamic bone disease or low bone turnover is the most common type of renal osteodystrophy. The consequences of CKD-MBD include increased fracture risk, greater morbidity, and mortality. Thus, the goal is to prevent the occurrences of fractures by means of alleviating CKD-induced MBD and treating subsequent osteoporosis. Changes in mineral and humoral metabolism as well as bone structure develop early in the course of CKD. CKD-MBD includes abnormalities of calcium, phosphorus, PTH, and/or vitamin D; abnormalities in bone turnover, mineralization, volume, linear growth, or strength; and/or vascular or other soft tissue calcification. In patients with CKD-MBD, using either DXA or FRAX to screen fracture risk should be considered. Biomarkers such as bALP and iPTH may assist to assess bone turnover. Before initiating an antiresorptive or anabolic agent to treat osteoporosis in CKD patients, lifestyle modifications, such as exercise, calcium, and vitamin D supplementation, smoking cessation, and avoidance of excessive alcohol intake are important. Managing hyperphosphatemia and SHPT are also crucial. Understanding the complex pathogenesis of CKD-MBD is crucial in improving one’s short- and long-term outcomes. Treatment strategies for CKD-associated osteoporosis should be patient-centered to determine the type of renal osteodystrophy. This review focuses on the mechanism, evaluation and management of patients with CKD-MBD. However, further studies are needed to explore more details regarding the underlying pathophysiology and to assess the safety and efficacy of agents for treating CKD-MBD.

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Section: Management Of Chronic Kidney Disease-mineral and Bone Dismentioning

confidence: 99%

Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review

Hsu

Chen

2020

IJMS

103

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“…We found four case reports and three case series reflecting treatment of 30 patients, summarized in Table . The case reports noted increased bone turnover and bone volume or BMD after 8 to 24 months of teriparatide given to 4 patients with biopsy‐proven ABD . Cejka and colleagues administered teriparatide for ≤6 months to 7 CKD patients with ABD based on PTH <100 pg/mL ( n = 6) or bone biopsy ( n = 1).…”

Section: Discussionmentioning

confidence: 99%

“…The case reports noted increased bone turnover and bone volume or BMD after 8 to 24 months of teriparatide given to 4 patients with biopsy-proven ABD. (17)(18)(19)(20) Cejka and colleagues (11) administered teriparatide for 6 months to 7 CKD patients with ABD based on PTH <100 pg/mL (n ¼ 6) or bone biopsy (n ¼ 1). Teriparatide significantly increased lumbar spine BMD without altering femoral neck BMD, bone turnover markers, or coronary artery calcification.…”

Section: Discussionmentioning

confidence: 99%

Teriparatide Treatment for Hypercalcemia Associated With Adynamic Bone Disease

Peugh

Khalil²,

Chan

et al. 2019

JBMR Plus

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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.

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“…An increase in bone turnover due to teriparatide in the context of bone-biopsy-confirmed ABD has also been demonstrated in some case reports [95,96], but to date no experience with abaloparatide or the new recombinant human PTH to control hypocalcemia in patients with hypoparathyroidism has been described in CKD patients [97].…”

Section: Anabolic Drugs For the Treatment Of Op Teriparatidementioning

confidence: 99%

Osteoporosis, bone mineral density and CKD–MBD: treatment considerations

et al. 2017

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Osteoporosis and chronic kidney disease (CKD) have both independently important potential impact on bone health. A significant number of patients with CKD stages 3a-5D have been shown to have low bone mineral density (BMD), leading to a strikingly elevated risk of fractures (mainly hip fractures) and higher associated morbidity and mortality. Mechanical properties of bone beyond age and menopausal status are additionally affected by intrinsic uremic factors. Therefore, we review in this article not only general concepts of osteoporosis and related consequences, but also the diagnostic and therapeutic implications of low BMD and bone fractures in CKD, beyond increased vascular calcification. Antiresorptive agents (mainly bisphosphonates) were not previously recommended when the estimated glomerular filtration rate (GFR) was lower than 30 ml/min/1.73 m. However, post-hoc analysis of large randomized clinical trials found that these drugs (i.e. alendronate, ribandronate, denosumab) had comparable efficacy in improving BMD and reducing fracture risk in individuals (mainly women) with moderate reductions of GFR (mostly CKD stages 3-4). Therefore, at least in the absence of clear abnormalities of CKD-related mineral metabolism disturbances, bone antiresorptive agents (and maybe anabolic agents) that are or will be approved for general osteoporosis may be appropriate for CKD. Nephrologists should probably not ignore any longer fracture risk assessment, especially in patients with additional risk factors for osteoporosis if results will impact treatment decisions. However, although different therapeutic agents have been shown to reduce the risk of fracture in CKD patients with low BMD, specific prospective studies, with or without bone biopsies, in CKD are urgently needed.

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Treatment of adynamic bone disease in a haemodialysis patient with teriparatide

Cited by 18 publications

References 8 publications

Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review

Osteoporosis in Patients with Chronic Kidney Diseases: A Systemic Review

Teriparatide Treatment for Hypercalcemia Associated With Adynamic Bone Disease

Osteoporosis, bone mineral density and CKD–MBD: treatment considerations

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