Effekte von Teriparatid auf knochenhistologische Parameter bei einer Patientin mit adynamer renaler Knochenerkrankung und Wirbelkörperfrakturen

Zusammenfassung

Humanes rekombinantes Teriparatid (1–34) ist ein Knochenaufbau-stimulierendes Peptidhormon. Die Behandlung mit Teriparatid führt zu einer Zunahme der Knochenmineraldichte und zu einer Steigerung des Knochenumbaus. In einer Dosierung von 20 µg – täglich subkutan appliziert – konnte eine Senkung des Frakturrisikos bei Frauen mit postmenopausaler Osteoporose, bei Männern mit idiopathischer oder hypogonadaler Osteo- porose und bei Patienten beiderlei Geschlechts mit Glukokortikoid-induzierter Osteoporose nachgewiesen werden. Wir berichten über eine 60-jährige Patientin mit einer chronischen Nierenfunktionseinschränkung im Stadium CKD-MBD 4 und multiplen Wirbelkörperfrakturen auf dem Boden einer adynamen renalen Knochenerkrankung nach Bisphosphonat- und Denosumab-Therapie, bei der die Behandlung mit Teriparatid über 20 Monate zu einer Zunahme des mineralisierten Knochens und des Knochenumbaus führte.

Summary

Human recombinant teriparatide (human parathyroid hormone 1–34 of recombinant DNA origin) is an osteoanabolic acting peptide hormone. Teriparatide treatment results in activation of bone remodeling and increases bone mineral density. Effects on bone structure, bone mass and bone quality have been demonstrated in histomorphometric studies. Once-daily subcutaneous administration was shown to be effective in reduction of fracture risk in postmeopausal osteoporosis, in idiopathic or hypogonadal osteoporosis in men and in glucocorticoid induced osteoporosis. There are only limited data about teriparatide effects in patients with elevated PTH levels due to renal insufficiency. We report a 60 year old woman with CKDMBD stage 4 and multiple vertebral fractures with adynamic renal bone disease due to bisphosphonate and denosumab therapy. Histomorphometric analysis of bone biopsies taken before and after treatment with teriparatide for 20 months demonstrate a considerable increase of mineralized bone volume and also stimulated bone resorption.

Schlüsselwörter

Teriparatid - Knochenumbau - adyname renale Knochenerkrankung

Keywords

Teriparatide - bone remodeling - adynamic renal bone disease

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