title: Impact of long-term cinacalcet, ibandronate or teriparatide therapy on bone mineral density of hemodialysis patients: a pilot study.
abstract: BACKGROUND
  Insufficient evidenced-based information is available for the treatment of osteoporosis in hemodialysis (HD) patients.
  
  
  METHODS
  In 102 HD patients, bone mineral density (BMD) was measured twice 16 ± 3 months apart. In the second BMD measurement 66 of them had a femoral neck (FN) T-score <-2.5. Of these 66 patients, 38 consented to a bone biopsy. Depending on both the bone biopsy findings and parathyroid hormone levels, patients were assigned to treatment groups. Eleven patients with osteitis fibrosa and iPTH >300 pg/ml received cinacalcet, 11 with osteitis fibrosa and iPTH <300 pg/ml received ibandronate, 9 with adynamic bone disease received teriparatide, and 7 with mild abnormalities received no treatment. A third BMD measurement was done after an average treatment period of 13-16 months. We compared the annual percent change of FN and lumbar spine (LS) BMD before and during treatment.
  
  
  RESULTS
  FN and LS BMD decreased significantly in the cinacalcet group, with an annual change of 3.6 and 3.4% before treatment to -4.2% (p = 0.04) and -7.7% (p = 0.02) during treatment, respectively. In the teriparatide group, FN and LS BMD increased, although not significantly, with an annual change of -5.4 and -2.6% before treatment to 2.7 and 4.9% during treatment, respectively. In both the ibandronate and the no treatment groups, BMD change rate remained negative during the whole study.
  
  
  CONCLUSIONS
  Teriparatide administration improved BMD in HD patients with adynamic bone disease, although these results did not reach statistical significance. In HD patients with osteitis fibrosa, ibandronate did not improve BMD while cinacalcet reduced BMD.
authors.affiliation: Department of Nephrology, Papageorgiou General Hospital, Thessaloniki, Greece. mitsopouloss@yahoo.com
authors.forename: Efstathios
authors.initials: E
authors.lastname: Mitsopoulos
authors.forename: Eudoxia
authors.initials: E
authors.lastname: Ginikopoulou
authors.forename: Dominiki
authors.initials: D
authors.lastname: Economidou
authors.forename: Stavros
authors.initials: S
authors.lastname: Zanos
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Pateinakis
authors.forename: Elias
authors.initials: E
authors.lastname: Minasidis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Memmos
authors.forename: Elias
authors.initials: E
authors.lastname: Thodis
authors.forename: Vassilis
authors.initials: V
authors.lastname: Vargemezis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Tsakiris
mesh_terms: D000368:Aged; D001706:Biopsy; D015519:Bone Density / Q000187:drug effects*; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D000069449:Cinacalcet; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D005272:Femur Neck / Q000473:pathology; D005357:Fibrous Dysplasia of Bone / Q000188:drug therapy; D006801:Humans; D000077557:Ibandronic Acid; D008159:Lumbar Vertebrae / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009281:Naphthalenes / Q000627:therapeutic use*; D010865:Pilot Projects; D006435:Renal Dialysis / Q000379:methods*; D012306:Risk; D019379:Teriparatide / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D009281:Naphthalenes; D019379:Teriparatide; D000069449:Cinacalcet; D000077557:Ibandronic Acid