Vetrano Daniele, Aguanno Francesco, Passaseo Alessia, Barbuto Simona, Tondolo Francesco, Catalano Veronica, Zavatta Guido, Pagotto Uberto, La Manna Gaetano, Cianciolo Giuseppe
Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy.
Nephrology, Dialysis and Kidney Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
Int Urol Nephrol. 2025 Jun;57(6):1965-1975. doi: 10.1007/s11255-025-04383-8. Epub 2025 Jan 27.
Kidney transplantation is the preferred treatment for end-stage kidney disease (ESKD), enhancing survival and quality of life. However, kidney transplant recipients (KTRs) are at high risk for bone disorders, particularly low bone turnover disease, which increases fracture risk. Teriparatide, an anabolic agent, may provide a beneficial treatment option for these patients.
This single-center, retrospective observational study involved 18 KTRs with osteoporosis, low bone turnover, and a history of vertebral or non-vertebral fractures. Patients received teriparatide (20 μg/day) for up to 2 years. Areal bone mineral density (aBMD) at the lumbar spine (LS), total hip (TH), femoral neck (FN), and trabecular bone score (TBS) were measured at baseline, 1 year, and 2 years. In addition, bone turnover markers (BTMs), serum calcium, phosphorus, parathyroid hormone (PTH), and kidney function were monitored.
Significant increases in LS aBMD were observed after 1 year (0.941 ± 0.152 vs 1.043 ± 0.165, p = 0.04) and maintained after 2 years compared to baseline (0.941 ± 0.152 vs 1.074 ± 0.154, p = 0.03). TH aBMD significantly increased after 2 years (0.753 ± 0.145 vs 0.864 ± 0.141, p = 0.04), while FN and TBS showed non-significant improvement. Teriparatide was well-tolerated, with mild and transient hypercalcemia and hypophosphatemia.
Teriparatide significantly improved BMD at the LS and TH in KTRs with osteoporosis and low bone turnover, showing a favorable safety profile.
肾移植是终末期肾病（ESKD）的首选治疗方法，可提高生存率和生活质量。然而，肾移植受者（KTRs）发生骨疾病的风险很高，尤其是低骨转换疾病，这会增加骨折风险。特立帕肽是一种促合成代谢药物，可能为这些患者提供有益的治疗选择。
这项单中心回顾性观察研究纳入了18例患有骨质疏松症、低骨转换且有椎体或非椎体骨折病史的KTRs。患者接受特立帕肽（20μg/天）治疗长达2年。在基线、1年和2年时测量腰椎（LS）、全髋（TH）、股骨颈（FN）的骨密度（aBMD）和骨小梁评分（TBS）。此外，监测骨转换标志物（BTMs）、血清钙、磷、甲状旁腺激素（PTH）和肾功能。
与基线相比，1年后LS的aBMD显著增加（0.941±0.152 vs 1.043±0.165，p = 0.04），2年后仍保持增加（0.941±0.152 vs 1.074±0.154，p = 0.03）。2年后TH的aBMD显著增加（0.753±0.145 vs 0.864±0.141，p = 0.04），而FN和TBS的改善不显著。特立帕肽耐受性良好，伴有轻度和短暂的高钙血症和低磷血症。
特立帕肽显著改善了骨质疏松和低骨转换的KTRs的LS和TH的骨密度，显示出良好的安全性。
