American Journal of Nephrology

Original Report: Patient-Oriented, Translational Research

Impact of Long-Term Cinacalcet, Ibandronate or Teriparatide Therapy on Bone Mineral Density of Hemodialysis Patients: A Pilot Study

Mitsopoulos E.a · Ginikopoulou E.a · Economidou D.b · Zanos S.c · Pateinakis P.a · Minasidis E.a · Memmos D.b · Thodis E.d · Vargemezis V.d · Tsakiris D.a

Author affiliations

aDepartment of Nephrology, Papageorgiou General Hospital, and bDepartment of Nephrology, Medical School, Aristotle University of Thessaloniki, Hippokration General Hospital, Thessaloniki, Greece; cDepartments of Neurological Surgery and Physiology and Biophysics, University of Washington School of Medicine, Seattle, Wash., USA; dDepartment of Nephrology, Medical School, Democritus University of Thrace, Alexandroupolis, Greece

Keywords: BisphosphonatesBone mineral densityChronic hemodialysisCalcimimeticsOsteoporosisRenal osteodystrophyTeriparatide

Related Articles for ""
Am J Nephrol 2012;36:238–244
https://doi.org/10.1159/000341864

Log in to MyKarger to check if you already have access to this content.




Forgot your password
Sign up to MyKarger

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more
CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!


If you would like to redeem your KAB credit, please log in.

Save over 20% compared to the individual article price.

Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply
Rental: USD 8.50
Cloud: USD 20.00

Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates

Select
* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Original Report: Patient-Oriented, Translational Research

Received: May 10, 2012
Accepted: July 11, 2012
Published online: August 31, 2012
Issue release date: September 2012

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 3

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: https://www.karger.com/AJN

Abstract

Background: Insufficient evidenced-based information is available for the treatment of osteoporosis in hemodialysis (HD) patients. Methods: In 102 HD patients, bone mineral density (BMD) was measured twice 16 ± 3 months apart. In the second BMD measurement 66 of them had a femoral neck (FN) T-score <–2.5. Of these 66 patients, 38 consented to a bone biopsy. Depending on both the bone biopsy findings and parathyroid hormone levels, patients were assigned to treatment groups. Eleven patients with osteitis fibrosa and iPTH >300 pg/ml received cinacalcet, 11 with osteitis fibrosa and iPTH <300 pg/ml received ibandronate, 9 with adynamic bone disease received teriparatide, and 7 with mild abnormalities received no treatment. A third BMD measurement was done after an average treatment period of 13–16 months. We compared the annual percent change of FN and lumbar spine (LS) BMD before and during treatment. Results: FN and LS BMD decreased significantly in the cinacalcet group, with an annual change of 3.6 and 3.4% before treatment to –4.2% (p = 0.04) and –7.7% (p = 0.02) during treatment, respectively. In the teriparatide group, FN and LS BMD increased, although not significantly, with an annual change of –5.4 and –2.6% before treatment to 2.7 and 4.9% during treatment, respectively. In both the ibandronate and the no treatment groups, BMD change rate remained negative during the whole study. Conclusions: Teriparatide administration improved BMD in HD patients with adynamic bone disease, although these results did not reach statistical significance. In HD patients with osteitis fibrosa, ibandronate did not improve BMD while cinacalcet reduced BMD.

© 2012 S. Karger AG, Basel



Related Articles:

References

  1. Atsumi K, Kushida K, Yamazaki K, Shimizu S, Ohmura A, Inoue T: Risk factors for vertebral fractures in renal osteodystrophy. Am J Kidney Dis 1999;33:287–293.
    External Resources
  2. Coco M, Rush DN: Increased incidence of hip fractures in dialysis patients with low serum parathyroid hormone. Am J Kidney Dis 2000;36:1115–1121.
    External Resources
  3. Jadoul M, Albert JM, Akiba T, Akizawa T, Arab L, Bragg-Gresham JL, Mason N, Prutz KG, Young EW, Pisoni RL: Incidence and risk factors for hip or other bone fractures among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study. Kidney Int 2006;70:1358–1366.
    External Resources
  4. Mittalhenkle A, Gillen DL, Stehman-Breen CO: Increased risk of mortality associated with hip fractures in the dialysis population. Am J Kidney Dis 2004;44:672–679.
    External Resources
  5. Jamal SA, Hodsman AB: Reducing the risk of re-fracture in the dialysis population: is it time to consider therapy with PTH analogues? Semin Dial 2011;24:12–15.
    External Resources
  6. Cunningham J, Sprague SM: Osteoporosis in chronic kidney disease. Am J Kidney Dis 2004;43:566–571.
    External Resources
  7. Miller PD: Treatment of Osteoporosis in chronic kidney disease and end-stage renal disease. Curr Osteoporos Rep 2005;3:5–12.
    External Resources
  8. Ott SM: Review article: Bone density in patients with chronic kidney disease stages 4–5. Nephrology (Carlton) 2009;14:395–403.
    External Resources
  9. Elder GJ, Mackun K: 25-Hydroxyvitamin D deficiency and diabetes predict reduced BMD in patients with chronic kidney disease. J Bone Miner Res 2006;21:1778–1784.
    External Resources
  10. Jamal SA, Hayden JA, Beyene J: Low bone mineral density and fractures in long-term hemodialysis patients: a meta-analysis. Am J Kidney Dis 2007;49:674–681.
    External Resources
  11. Inaba M, Okuno S, Kumeda Y, Yamakawa T, Ishimura E, Nishizawa Y: Increased incidence of vertebral fracture in older female hemodialyzed patients with type 2 diabetes mellitus. Calcif Tissue Int 2005;76:256–260.
    External Resources
  12. Kaji H, Suzuki M, Yano S, Sugimoto T, Chihara K, Hattori S, Sekita K: Risk factors for hip fracture in hemodialysis patients. Am J Nephrol 2002;22:325–331.
    External Resources
  13. Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ 3rd, Khaltaev N: A reference standard for the description of osteoporosis. Bone 2008;42:467–475.
    External Resources
  14. Coen G, Mazzaferro S, Ballanti P, Chicca S, Manni M, Bonucci E, Taggi F: Renal bone disease in 76 patients with varying degrees of predialysis chronic renal failure: a cross-sectional study. Nephrol Dial Transplant 1996;11:813–819.
    External Resources
  15. Bergner R, Dill K, Boerner D, Uppenkamp M: Elimination of intravenously administered ibandronate in patients on haemodialysis: a monocentre open study. Nephrol Dial Transplant 2002;17:1281–1285.
    External Resources
  16. Lien YHH, Silva AL, Whittman D: Effects of cinacalcet on bone mineral density in patients with secondary hyperparathyroidism. Nephrol Dial Transplant 2005;20:1232–1237.
    External Resources
  17. Cunningham J, Danese M, Olson K, Klassen P, Chertow GM: Effects of the calcimimetic cinacalcet HCl on cardiovascular disease, fracture, and health-related quality of life in secondary hyperparathyroidism. Kidney Int 2005;68:1793–1800.
    External Resources
  18. Malluche HH, Monier-Faugere MC, Wang G, Fraza JM, Charytan C, Coburn JW, Coyne DW, Kaplan MR, Baker N, McCary LC, Turner SA, Goodman WG: An assessment of cinacalcet HCl effects on bone histology in dialysis patients with secondary hyperparathyroidism. Clin Nephrol 2008;69:269–278.
    External Resources
  19. Finch JL, Tokumoto M, Nakamura H, Yao W, Shahnazari M, Lane N, Slatopolsky E: Effect of paricalcitol and cinacalcet on serum phosphate, FGF-23, and bone in rats with chronic kidney disease. Am J Physiol Renal Physiol 2010;298:F1315–F1322.
    External Resources
  20. Nguyen-Yamamoto L, Bolivar I, Strugnell SA, Goltzman D: Comparison of active vitamin D compounds and a calcimimetic in mineral homeostasis. J Am Soc Nephrol 2010;21:1713–1723.
    External Resources
  21. Peacock M, Bolognese MA, Borofsky M, Cumpia S, Sterling LR, Cheng S, Shoback D: Cinacalcet treatment of primary hyperparathyroidism: biochemical and bone densitometric outcomes in a five-year study. J Clin Endocrinol Metab 2009;94:4860–4867.
    External Resources
  22. Norman J, Lopez J, Politz D: Cinacalcet (Sensipar) provides no measurable clinical benefits for patients with primary hyperparathyroidism and may accelerate bone loss with prolonged use. Ann Surg Oncol 2012;19:1466–1471.
    External Resources
  23. Huraib S, Abu-Aisha H, Abed J, Al Wakeel J, Al Desouki M, Memon N: Long-term effect of intravenous calcitriol on the treatment of severe hyperparathyroidism, parathyroid gland mass and bone mineral density in haemodialysis patients. Am J Nephrol 1997;17:118–123.
    External Resources
  24. Nakane M, Fey TA, Dixon DB, Ma J, Brune ME, Li YC, Wu-Wong JR: Differential effects of vitamin D analogs on bone formation and resorption. J Steroid Biochem Mol Biol 2006;98:72–77.
    External Resources
  25. Hodsman AB, Bauer DC, Dempster DW, Dian L, Hanley DA, Harris ST, Kendler DL, McClung MR, Miller PD, Olszynnski WP, Orwoll E, Yuen CK: Parathyroid hormone and teriparatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use. Endocr Rev 2005;26:688–703.
    External Resources
  26. KDIGO Clinical Practice Guideline for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Chapter 4.3. Kidney Int 2009;76(suppl 113):S90–S99.
  27. Cejka D, Kodras K, Bader T, Haas M: Treatment of hemodialysis-associated adynamic bone disease with teriparatide (PTH1–34): a pilot study. Kidney Blood Press Res 2010;33:221–226.
    External Resources
  28. Bergner R, Henrich D, Hoffmann M, Schmidt-Gayk H, Lenz T, Upperkamp M: Treatment of reduced bone density with ibandronate in dialysis patients. J Nephrol 2008;21:510–516.
    External Resources

Article / Publication Details

First-Page Preview
Abstract of Original Report: Patient-Oriented, Translational Research

Received: May 10, 2012
Accepted: July 11, 2012
Published online: August 31, 2012
Issue release date: September 2012

Number of Print Pages: 7
Number of Figures: 1
Number of Tables: 3

ISSN: 0250-8095 (Print)
eISSN: 1421-9670 (Online)

For additional information: https://www.karger.com/AJN

Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Article Tools
Article Details

2012, Vol.36, No. 3

September 2012

Article

Recommend This
TOP