Effect of teriparatide on early bone loss after kidney transplantation.
Kidney transplantation is associated with bone loss and a high risk of fractures. Prophylactic treatment of bone is therefore recommended in the early posttransplant period. As a large number of transplant recipients develop adynamic renal osteodystrophy, recombinant parathyroid hormone (rPTH) could be a promising therapeutic option. In a 6-month double-blind, randomized trial, 26 kidney transplant recipients were treated with daily subcutaneous injections of 20 microg teriparatide (PTH 1-34) or placebo. Bone mineral density (BMD) of the femoral neck, lumbar spine and radial bone was measured at transplantation and after 6 months. Paired bone biopsies for histomorphometric analysis were obtained in six, and for measurement of bone matrix mineralization in five patients of each group. Serologic bone markers were measured at baseline and every 3 months. A total of 24 out of 26 patients completed the study. Femoral neck BMD was stable in the teriparatide group, but decreased significantly in the placebo group. Lumbar spine and radial BMD, histomorphometric bone volume and bone matrix mineralization status remained unchanged in both groups. Serologic bone markers were similarly reduced in both groups throughout the study. We conclude that teriparatide does not improve BMD early after kidney transplantation. Neither histological analysis nor bone markers provide evidence of improved bone turnover or mineralization.
Cejka
D
D
Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University Vienna, Vienna, Austria.
Benesch
T
T
Krestan
C
C
Roschger
P
P
Klaushofer
K
K
Pietschmann
P
P
Haas
M
M
D000328:Adult; D000469:Alkaline Phosphatase / Q000378:metabolism; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy*; D002112:Calcifediol / Q000097:blood; D002117:Calcitriol / Q000097:blood; D003404:Creatinine / Q000097:blood; D004311:Double-Blind Method; D005260:Female; D005272:Femur Neck / Q000187:drug effects / Q000601:surgery; D006801:Humans; D016030:Kidney Transplantation; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000601:surgery; D008297:Male; D008875:Middle Aged; D015675:Osteocalcin / Q000378:metabolism; D010281:Parathyroid Hormone / Q000097:blood; D011884:Radius / Q000187:drug effects / Q000601:surgery; D011994:Recombinant Proteins / Q000627:therapeutic use; D019379:Teriparatide / Q000627:therapeutic use*; D013997:Time Factors
D015415:Biomarkers; D050071:Bone Density Conservation Agents; D010281:Parathyroid Hormone; D011994:Recombinant Proteins; D015675:Osteocalcin; D019379:Teriparatide; D003404:Creatinine; D000469:Alkaline Phosphatase; D002117:Calcitriol; D002112:Calcifediol