Teriparatide treatment in a heart transplant patient with a chronic kidney disease and a low-turnover bone disease: a case report.
Teriparatide treatment in a heart transplant patient with a chronic kidney disease and a low-turnover bone disease: a case report.
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DOI：
10.1007/s00198-016-3858-2
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发表时间：
2017-03
期刊：
影响因子：
--
通讯作者：
Dimai H
中科院分区：
文献类型：
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作者：
Fahrleitner-Pammer A;Wagner D;Krisper P;Amrein K;Dimai H
低周转率骨病是慢性肾脏疾病和长期类固醇治疗的并发症。目前，唯一可用的骨合成代谢治疗是特立帕肽（TPTD）。到目前为止，还没有关于心脏移植患者的数据，只有一例低周转率骨病透析患者的组织形态计量学分析被发表。目前的报告显示了1年TPTD治疗在接受三联免疫抑制治疗并发慢性肾衰竭的心脏移植患者10个椎体骨折和3个外周骨折的效果。在治疗前和治疗1年后进行四环素标记后的经髂骨活检，显示骨形成增加，结构指标改善（样骨体积/骨体积增加20倍，样骨表面/骨表面增加4倍，壁厚增加（+15%），小梁厚度增加（+9%），小梁数量增加（+38%））。骨密度稳定，无新的椎体骨折发生，治疗耐受性良好，患者临床改善。
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.