Division of Endocrinology and Metabolism, University of Toronto and Women's College Research Institute, Toronto, Canada.
Department of Medicine, Université de Montréal, Bone Histomorphometry Laboratory, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada.
Am J Kidney Dis. 2015 Jun;65(6):933-6. doi: 10.1053/j.ajkd.2015.01.025. Epub 2015 Apr 2.
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.
特立帕肽，甲状旁腺激素的一种重组形式，是一种合成代谢药物，已被批准用于治疗骨质疏松症的男性和女性患者。然而，它在慢性肾脏病（CKD）患者中的研究并不充分。我们报告了一名接受透析治疗的 5 期 CKD 患者，他因多处骨折就诊，包括双侧无移位骨盆骨折，导致慢性疼痛并影响患者的工作能力。骨组织形态计量学显示低转换骨疾病，他接受了为期 24 个月的 20μg 特立帕肽（皮下注射）治疗。在开始治疗的 6 个月内，患者的疼痛得到缓解，能够恢复工作。他的血清钙和磷水平在整个治疗期间均保持在参考范围内，且未再发生骨折。在 24 个月的治疗期间，腰椎的骨密度得以维持，股骨颈和全髋关节的骨密度分别增加了 4%。第二次髂骨活检显示骨形成的静态和动态参数均有所改善。在我们的患者中，24 个月的特立帕肽治疗是安全有效的；然而，需要更大规模的研究来确定特立帕肽在依赖透析的 CKD 患者中的疗效。
