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Ther Apher Dial. 2019 Jun 18. doi: 10.1111/1744-9987.12867. [Epub ahead of print]

The impact of weekly teriparatide on the bone and mineral metabolism in hemodialysis patients with relatively low serum parathyroid hormone: a pilot study.

Author information

1
Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
2
Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
3
Department of Nephrology, Japan Community Health Care Organization, Sapporo Hokushin Hospital, Sapporo, Japan.
4
Department of Nephrology, Hokkaido Medical Center, Sapporo, Japan.
5
Department of Hemodialysis, Hokko Memorial Hospital, Sapporo, Japan.
6
Department of Hemodialysis, Ogasawara Memorial Sapporo Hospital, Sapporo, Japan.

Abstract

Adynamic bone disease (ABD) in hemodialysis (HD) patients is characterized by skeletal resistance to parathyroid hormone (PTH) or suppression of PTH release, leading to a down-regulated bone turnover and bone fracture. Hence, we examined the efficacy of weekly teriparatide for HD patients with low PTH indicating ABD without a history of parathyroidectomy. Fifteen HD patients with low PTH were recruited in this prospective observational study. Of them, 10 received teriparatide for 12 months and 5 non-treated patients were enrolled as control. Primary outcomes were defined as the changes in bone mineral density (BMD) and bone turnover markers. BMD at the lumbar spine increased by 3.7 % and 2.5 % at 6 and 12 month and bone formation markers increased, while bone resorption markers did not change in the teriparatide group. At 12 months after teriparatide administration, endogenous PTH was secreted followed by the recovery of low bone turnover. 40% patients in the teriparatide group dropped out due to adverse events and most common adverse event was transient hypotension. This study suggests that weekly teriparatide for HD patients with low PTH in the absence of parathyroidectomy accelerates bone formation and bone turnover, leading to increased trabecular bone mass and secretion of endogenous PTH. This article is protected by copyright. All rights reserved.

KEYWORDS:

Chronic kidney disease-mineral and bone disorder; Low parathyroid hormone, Osteoporosis, Teriparatide; Low-turnover bone disease

PMID:
31210004
DOI:
10.1111/1744-9987.12867

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