title: Efficacy and safety of osteoporosis medications in a rat model of late-stage chronic kidney disease accompanied by secondary hyperparathyroidism and hyperphosphatemia.
abstract: This study showed that bisphosphonate was safe and effective for the treatment of bone disorders in stage 4 chronic kidney disease (CKD) rats. Intermittent teriparatide therapy showed an anabolic action on bone even under secondary hyperparathyroidism conditions without having an adverse effect on mineral metabolism in late-stage CKD.
  
  
  
  Patients with late-stage CKD are at high risk for fragility fractures. However, there are no consensus on the efficacy and safety of osteoporosis medications for patients with late-stage CKD. In the present study, we aimed to examine the efficacy and safety of alendronate (ALN) and teriparatide (TPD) for treating bone disorder in late-stage CKD with pre-existing secondary hyperparathyroidism using a rat model of CKD.
  
  
  
  Male 10-week-old Sprague-Dawley rats were subjected to a 5/6 nephrectomy or sham surgery and randomized into the following four groups: sham, vehicle (saline subcutaneous (sc) daily), ALN (50 μg/kg sc daily), and TPD (40 μg/kg sc daily). Medications commenced at 24 weeks of age and continued for 4 weeks. Micro-computed tomography, histological analysis, infrared spectroscopic imaging, and serum assays were performed.
  
  
  
  Nephrectomized rats developed hyperphosphatemia, secondary hyperparathyroidism (SHPT), and high creatinine, equivalent to CKD stage 4 in humans. ALN suppressed the bone turnover and increased the degree of mineralization in cortical bone, resulting in an improvement in the mechanical properties. TPD further increased the bone turnover and significantly increased the degree of mineralization, micro-geometry, and bone volume, resulting in a significant improvement in the mechanical properties. Both ALN and TPD had no adverse effect on renal function and mineral metabolism.
  
  
  
  BP is safe and effective for the treatment of bone disorders in stage 4 CKD rats. Intermittent TPD therapy showed an anabolic action on bone even under SHPT conditions without having an adverse effect on mineral metabolism in late-stage CKD.
authors.affiliation: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Ota
authors.affiliation: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan. takamasa@med.hokudai.ac.jp.
authors.forename: M
authors.initials: M
authors.lastname: Takahata
authors.affiliation: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Shimizu
authors.affiliation: Chitose Institute of Science and Technology, Chitose, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kanehira
authors.affiliation: Chitose Institute of Science and Technology, Chitose, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Kimura-Suda
authors.affiliation: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Kameda
authors.affiliation: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors.forename: H
authors.initials: H
authors.lastname: Hamano
authors.affiliation: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Hiratsuka
authors.affiliation: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors.forename: D
authors.initials: D
authors.lastname: Sato
authors.affiliation: Department of Orthopedic Surgery, Hokkaido University Graduate School of Medicine, Kita-15 Nishi-7, Kita-ku, Sapporo, 060-8638, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Iwasaki
mesh_terms: D019386:Alendronate / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use; D000818:Animals; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D016723:Bone Remodeling / Q000187:drug effects; D004195:Disease Models, Animal; D004353:Drug Evaluation, Preclinical / Q000379:methods; D005269:Femur / Q000000981:diagnostic imaging / Q000187:drug effects / Q000378:metabolism; D006962:Hyperparathyroidism, Secondary / Q000150:complications*; D054559:Hyperphosphatemia / Q000150:complications*; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000187:drug effects; D008297:Male; D009392:Nephrectomy; D010024:Osteoporosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D017207:Rats, Sprague-Dawley; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D019379:Teriparatide / Q000494:pharmacology; D055114:X-Ray Microtomography
chemical_list: D050071:Bone Density Conservation Agents; D019379:Teriparatide; D019386:Alendronate
keywords: Bone quality; Chronic kidney disease; Hyperphosphatemia; Osteoporosis medication; Secondary hyperparathyroidism