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      Teriparatide Treatment for Hypercalcemia Associated With Adynamic Bone Disease

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          Abstract

          Hypercalcemia most often results from primary hyperparathyroidism and malignancy. Adynamic bone disease (ABD) is a form of renal osteodystrophy characterized by reduced bone turnover, which can limit the ability of bone to release or store calcium, potentially leading to low, normal, or high serum calcium levels. We describe a 51‐year‐old dialysis‐dependent female with hypercalcemia after parathyroidectomy. A demeclocycline‐labeled bone biopsy confirmed adynamic bone disease. Teriparatide, a recombinant form of parathyroid hormone (PTH) used to treat postmenopausal osteoporosis, was prescribed for 12 months and normalized serum calcium levels. Although previous case reports and series have described favorable changes in spine bone mineral density when teriparatide was prescribed for ABD, ours is the first documented case in which teriparatide resolved hypercalcemia due to ABD. © 2019 The Authors. JBMR Plus published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research.

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          Renal osteodystrophy in the first decade of the new millennium: analysis of 630 bone biopsies in black and white patients.

          Marie-Claude Faugere, Hartmut Malluche, Hanna W Mawad (2011)
          Renal osteodystrophy occurs early during loss of kidney function. There are 26 million American patients with chronic kidney disease (CKD), and almost all patients with CKD stage 5 have abnormal bone histology. Six hundred and thirty bone biopsies from adult CKD-5 patients on dialysis were evaluated by histomorphometry and analyzed using the turnover (T), mineralization (M), and volume (V) classification. There were racial differences; whites exhibited predominantly low turnover (62%), whereas blacks showed mostly normal or high turnover (68%). A mineralization defect was observed in only 3% of patients. In whites, cancellous bone volume was low, normal, or high in approximately the same number of patients, whereas in blacks, cancellous bone volume was high in two-thirds of the patients. More than 80% of blacks and whites with low cancellous bone volume had thin trabeculae owing to low bone formation. Cortical thickness was low in half the whites, whereas it was normal in three-quarters of blacks. Cortical porosity was high in 50% of whites, whereas three-quarters of blacks had high porosity. In summary, the TMV system gives relevant information. It should be expanded to include the architecture of cancellous and cortical bone. There are racial differences. Low bone volume and low bone turnover are more frequent than heretofore appreciated, whereas mineralization defects nowadays are observed rarely in adults. These findings call for an adjustment of the current therapeutic paradigm that takes into consideration race and risk of low bone volume and turnover. The latter have been shown to be associated with increased vascular calcifications. Copyright © 2011 American Society for Bone and Mineral Research.
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            Diagnostic Accuracy of Bone Turnover Markers and Bone Histology in Patients With CKD Treated by Dialysis.

            Stuart Sprague, Ezequiel Bellorin-Font, Vanda Jorgetti … (2016)
            The management of chronic kidney disease-mineral and bone disorder requires the assessment of bone turnover, which most often is based on parathyroid hormone (PTH) concentration, the utility of which remains controversial.
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              Teriparatide in postmenopausal women with osteoporosis and mild or moderate renal impairment.

              D. Misurski, Charles E Schwartz, Megan P. Miller … (2006)
              The prevalence of both osteoporosis and renal impairment increases with age. Using data from the Fracture Prevention Trial, the safety and efficacy of teriparatide [rhPTH(1-34)] in postmenopausal women with osteoporosis and renal impairment were explored. Patients were required to have serum creatinine concentrations or =80 ml/min), mildly impaired (GFR 50-79 ml/min), or moderately impaired (GFR 30-49 ml/min) renal function for bone mineral density (BMD) and amino-terminal extension peptide of procollagen type 1 (PINP) analyses, and normal (GFR > or =80 ml/min) or impaired (GFR 0.05). Similarly, teriparatide-mediated vertebral and nonvertebral fracture risk reductions were similar and did not differ significantly between patients with normal or impaired renal function (treatment-by-subgroup interactions p>0.05). The incidences of treatment-emergent and renal-related adverse events were consistent across treatment assignment in the normal, mildly impaired, and moderately impaired renal function subgroups. Teriparatide induced changes in mean GFR were unaffected by baseline renal function (treatment-by-renal function interaction p>0.05 for normal, mildly impaired, or moderately impaired subgroups). Patients in all renal function categories treated with teriparatide 20 or 40 mcg had an increased incidence of 4-6-h postdose serum calcium >10.6 mg/dl (the upper limit of normal) versus placebo; however, teriparatide 20 mcg/day was not associated with significantly increased incidence of 4-6-h postdose serum calcium >11 mg/dl in any renal function category. Teriparatide therapy was associated with increased incidence of elevated uric acid, with the incidences being highest in patients with moderately impaired renal function and in those receiving teriparatide 40 mcg/day. Even so, adverse event data did not suggest an increased incidence of gout or arthralgia or of nephrolithiasis events in teriparatide-treated patients with normal, mild, or moderate renal impairment.
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                Author and article information

                Contributors
                Karen E Hansen: keh@medicine.wisc.edu
                Journal
                Journal ID (nlm-ta): JBMR Plus
                Journal ID (iso-abbrev): JBMR Plus
                Journal ID (doi): 10.1002/(ISSN)2473-4039
                Journal ID (publisher-id): JBM4
                Title: JBMR Plus
                Publisher: John Wiley and Sons Inc. (Hoboken )
                ISSN (Electronic): 2473-4039
                Publication date (Electronic): 27 February 2019
                Publication date Collection: July 2019
                Volume: 3
                Issue: 7 ( doiID: 10.1002/jbm4.v3.7 )
                Electronic Location Identifier: e10176
                Affiliations
                [ 1 ] Internal Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
                [ 2 ] Department of Orthopedics and Rehabilitation University of Wisconsin School of Medicine and Public Health Madison WI USA
                [ 3 ] Nephrology Division Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
                [ 4 ] Rheumatology Division Department of Medicine University of Wisconsin School of Medicine and Public Health Madison WI USA
                Author notes
                [*] [* ] Address correspondence to: Karen E Hansen, MD, Division of Rheumatology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Room 4124 MFCB, 1685 Highland Avenue, Madison, WI 53705‐2281, USA. E‐mail: keh@ 123456medicine.wisc.edu

                Article
                Publisher ID: JBM410176
                DOI: 10.1002/jbm4.10176
                PMC ID: 6659444
                SO-VID: 3e6ba87d-d9b5-4c70-b1fb-5dc227736c14
                Copyright © © 2019 The Authors. JBMR Plus Published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research
                License:

                This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 06 September 2018
                Date revision received : 05 December 2018
                Date accepted : 11 December 2018
                Page count
                Figures: 2, Tables: 1, Pages: 5, Words: 3005
                Categories
                Subject: Case Report
                Subject: Case Reports
                Custom metadata
                source-schema-version-number 2.0
                component-id jbm410176
                cover-date July 2019
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_NLMPMC version:5.6.6.2 mode:remove_FC converted:26.07.2019

                Keywords: hypercalcemia,teriparatide,adynamic bone disease,ckd‐mbd,dialysis
                Data availability:
                Keywords: hypercalcemia, teriparatide, adynamic bone disease, ckd‐mbd, dialysis

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