title: Teriparatide and bone turnover and formation in a hemodialysis patient with low-turnover bone disease: a case report.
abstract: Teriparatide, a recombinant form of parathyroid hormone, is an anabolic agent approved for use in women and men with osteoporosis. However, it is not well studied in people with chronic kidney disease (CKD). We report on a patient with stage 5 CKD treated with dialysis who presented to our clinic with multiple fractures, including bilateral nondisplaced pelvic fractures resulting in chronic pain and interfering with the patient's ability to work. Bone histomorphometry demonstrated low-turnover bone disease, and he was treated with 20μg of teriparatide (subcutaneous injection) every morning for 24 months. Within 6 months of initiating therapy, the patient's pain resolved and he was able to resume work. Serum calcium and phosphate levels remained within reference ranges throughout his treatment, and he sustained no further fractures. During 24 months of treatment, bone mineral density was maintained at the lumbar spine, and there was an increase of 4% at the femoral neck and total hip. A second transiliac bone biopsy demonstrated improvements in static and dynamic parameters of bone formation. In our patient, 24-month treatment with teriparatide was safe and effective; however, larger studies are needed to determine the efficacy of teriparatide in the dialysis-dependent CKD population.
authors.affiliation: Division of Endocrinology and Metabolism, University of Toronto and Women's College Research Institute, Toronto, Canada.
authors.forename: Patricia
authors.initials: P
authors.lastname: Palcu
authors.affiliation: Department of Medicine, Université de Montréal, Bone Histomorphometry Laboratory, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors.forename: Natalie
authors.initials: N
authors.lastname: Dion
authors.affiliation: Department of Medicine, Université de Montréal, Bone Histomorphometry Laboratory, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
authors.forename: Louis-Georges
authors.initials: LG
authors.lastname: Ste-Marie
authors.affiliation: Department of Medicine, McGill University, Montreal, QC, Canada; Department of Medicine, McGill University Health Centre, Montreal, QC, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Goltzman
authors.affiliation: Division of Endocrinology and Metabolism, University of Toronto and Women's College Research Institute, Toronto, Canada.
authors.forename: Ina
authors.initials: I
authors.lastname: Radziunas
authors.affiliation: University of Colorado Health Sciences Center and Colorado Center for Bone Research, Lakewood, CO.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Miller
authors.affiliation: Division of Endocrinology and Metabolism, University of Toronto and Women's College Research Institute, Toronto, Canada. Electronic address: sophie.jamal@utoronto.ca.
authors.forename: Sophie A
authors.initials: SA
authors.lastname: Jamal
mesh_terms: D000328:Adult; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001851:Bone Diseases, Metabolic / Q000188:drug therapy* / Q000209:etiology; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis; D019379:Teriparatide / Q000627:therapeutic use*
chemical_list: D050071:Bone Density Conservation Agents; D019379:Teriparatide
keywords: Teriparatide; adynamic bone disease; bone mineral density (BMD); chronic kidney disease (CKD); end-stage renal disease (ESRD); hemodialysis; low-turnover bone disease; recombinant intact parathyroid hormone (iPTH)