From the Guidelines
Teriparatide is a viable treatment option for kidney transplant recipients with osteoporosis, but its use requires careful consideration of the patient's complex bone disorder and close monitoring of serum calcium and renal function. The efficacy and safety of teriparatide in kidney transplantation recipients can be evaluated based on its effects on bone mineral density and fracture risk. According to recent studies, teriparatide has demonstrated significant improvements in bone mineral density, particularly at the lumbar spine and femoral neck, and may reduce fracture risk 1. However, kidney transplant recipients often have complex bone disorders due to pre-existing chronic kidney disease-mineral bone disorder, effects of immunosuppressive medications, and persistent hyperparathyroidism. Some key considerations for the use of teriparatide in this population include:
- Baseline assessment of serum calcium, phosphorus, and parathyroid hormone levels before initiating treatment
- Regular monitoring of serum calcium during treatment to avoid worsening hypercalcemia in patients with persistent hyperparathyroidism
- Monitoring of renal function, although teriparatide does not typically cause significant nephrotoxicity
- Avoidance of the medication in patients with severe hypercalcemia, unexplained elevated alkaline phosphatase, history of skeletal malignancies, or prior radiation therapy to the skeleton The standard dosing regimen for teriparatide is 20 mcg administered subcutaneously once daily for up to 24 months. Treatment decisions should be individualized based on the patient's specific bone disorder, time since transplantation, immunosuppressive regimen, and renal function.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Efficacy of Teriparatide in Kidney Transplantation Recipients
- Teriparatide has been shown to improve bone mineral density (BMD) in kidney transplant recipients with osteoporosis and low bone turnover 2.
- A significant increase in areal bone mineral density (aBMD) at the lumbar spine (LS) was observed after 1 year of teriparatide treatment, and this increase was maintained after 2 years 2.
- Total hip (TH) aBMD also significantly increased after 2 years of teriparatide treatment 2.
- However, another study found that teriparatide did not improve BMD early after kidney transplantation, and neither histological analysis nor bone markers provided evidence of improved bone turnover or mineralization 3.
Safety of Teriparatide in Kidney Transplantation Recipients
- Teriparatide was well-tolerated in kidney transplant recipients, with mild and transient hypercalcemia and hypophosphatemia 2.
- No serious adverse drug reactions were recorded in a postmarketing surveillance study of teriparatide in patients with severe stages of chronic kidney disease (CKD) 4.
- Teriparatide therapy was also effective in treating severe and prolonged hypocalcemia after kidney transplantation in parathyroidectomized patients, with no secondary effects observed and stable creatinemia 5.
Use of Teriparatide in Specific Patient Populations
- Teriparatide may be a useful treatment option for kidney transplant recipients with osteoporosis and low bone turnover, particularly those with a history of vertebral or non-vertebral fractures 2.
- Teriparatide may also be effective in treating osteoporosis in patients with severe stages of CKD, although it should be prescribed with caution in these patients 4.
- The use of teriparatide in kidney transplant recipients requires careful consideration of the potential benefits and risks, as well as individualization of therapy based on patient-specific factors 6.