title: Teriparatide treatment in a heart transplant patient with a chronic kidney disease and a low-turnover bone disease: a case report.
abstract: Low-turnover bone disease is a complication of chronic kidney disease and a long-term steroid therapy. Currently, the only bone anabolic treatment available is teriparatide (TPTD). So far, no data exist in heart transplant patients, and only one single case with histomorphometric analysis of a dialysis patient with a low-turnover bone disease has been published. The current report shows the effect of a 1-year TPTD therapy in a cardiac transplant patient with 10 vertebral and 3 peripheral fractures who had developed a chronic kidney failure while receiving triple immunosuppressive therapy. A transiliac bone biopsy following tetracycline labeling was performed prior and after 1 year of treatment, showing an increase in the bone formation and improvement of the structural indices (20-fold increase of osteoid volume/bone volume, fourfold increase of osteoid surface/bone surface and increases of wall thickness (+15%), trabecular thickness (+9%), and trabecular number (+38%)). Bone mineral density was stable, no new vertebral fractures had occurred, the therapy was well-tolerated, and the patient improved clinically.
authors.affiliation: Division of Endocrinology and Diabetes, Department of Internal Medicine, Medical University, Auenbruggerplatz 15, 8036, Graz, Austria. astrid.fahrleitner@medunigraz.at.
authors.forename: A
authors.identifier: http://orcid.org/0000-0002-5590-0888
authors.initials: A
authors.lastname: Fahrleitner-Pammer
authors.affiliation: Division of Transplantation, Department of Surgery, Medical University, Auenbruggerplatz 17, 8036, Graz, Austria.
authors.forename: D
authors.initials: D
authors.lastname: Wagner
authors.affiliation: Division of Nephrology and Dialysis, Department of Internal Medicine, Medical University, Auenbruggerplatz 21, 8036, Graz, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Krisper
authors.affiliation: Division of Endocrinology and Diabetes, Department of Internal Medicine, Medical University, Auenbruggerplatz 15, 8036, Graz, Austria.
authors.forename: K
authors.initials: K
authors.lastname: Amrein
authors.affiliation: Division of Endocrinology and Diabetes, Department of Internal Medicine, Medical University, Auenbruggerplatz 15, 8036, Graz, Austria.
authors.forename: H
authors.initials: H
authors.lastname: Dimai
mesh_terms: D015519:Bone Density / Q000187:drug effects; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D016723:Bone Remodeling / Q000187:drug effects; D005938:Glucocorticoids / Q000009:adverse effects; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D058866:Osteoporotic Fractures / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D019379:Teriparatide / Q000627:therapeutic use*
chemical_list: D050071:Bone Density Conservation Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D019379:Teriparatide
keywords: Bone biopsy; Cardiac transplantation; Histomorphometrie; Low-turn over bone disease in CKD-MBD; Teriparatide