Teriparatide treatment in a heart transplant patient with a chronic kidney disease and a low-turnover bone disease: a case report

• Published in: Osteoporosis international 2017-03, Vol.28 (3), p.1149-1152
• Main Authors: Fahrleitner-Pammer, A., Wagner, D., Krisper, P., Amrein, K., Dimai, H.
• Format: Article
• Language: English
• Subjects: Biopsy; Bone Density - drug effects; Bone Density Conservation Agents - therapeutic use; Bone diseases; Bone growth; Bone mineral density; Bone Remodeling - drug effects; Bone turnover; Cancellous bone; Case Report; Case reports; Dialysis; Endocrinology; Fractures; Glucocorticoids - adverse effects; Heart diseases; Heart transplantation; Heart Transplantation - adverse effects; Heart transplants; Humans; Immunosuppressive agents; Immunosuppressive Agents - adverse effects; Kidney diseases; Kidney Failure, Chronic - complications; Kidney transplantation; Kidney transplants; Male; Medicine; Medicine & Public Health; Middle Aged; Orthopedics; Osteogenesis; Osteoid; Osteoporosis; Osteoporosis - drug therapy; Osteoporosis - etiology; Osteoporosis - physiopathology; Osteoporotic Fractures - etiology; Osteoporotic Fractures - physiopathology; Osteoporotic Fractures - prevention & control; Parathyroid hormone; Patients; Renal failure; Rheumatology; Teriparatide - therapeutic use; Transplants & implants; Vertebrae
• ISSN: 0937-941X; 1433-2965
• DOI: 10.1007/s00198-016-3858-2

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.