The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Teriparatide-induced Sever Persistent Hypercalcemia in an Osteoporotic Patient: A Case Report and Literature Review

Document Type : CASE REPORT

Authors
Sedigheh Reisian 1
Shokoufeh Bonakdaran 1
Ali Moradi PhD 2
Mohammad Ali Yaghoubi 1
1 Metabolic Syndrome Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
2 2 Clinical Research Development Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran 3 Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
10.22038/abjs.2024.80907.3690
Abstract
A rare case of severe prolonged persistent Teriparatide-induced hypercalcemia (14.3mg/dL on admission) in an osteoporotic patient after ceasing the Teriparatide is reported. This 67-year-old female was admitted with polyuria, xerostomia, constipation, progressive weakness, and a history of Triparatide use due to a previous osteoporotic fracture. Her serum calcium, PTH, and vitamin D levels had been normal before starting Teriparatide. Ninety six hours after ceasing the Teriparatide along with rehydration and Calcitonin treatment, the patient's serum calcium levels returned to normal. Severe Teriparatide-induced hypercalcemia does not follow any defined pattern and may persist for days and can usually be controlled through ceasing the Teriparatide, rehydration, and close monitoring of the serum calcium level and symptoms.
        Level of evidence: IV
Keywords
Hypercalcemia
Osteoporosis
Teriparatide
Subjects
  1. Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006; 17(12):1726-33. doi:10.1007/s00198-006-0172-4.
  2. Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019; 393(10169):364-376. doi:10.1016/s0140-6736(18)32112-3.
  3. Canalis E, Giustina A, Bilezikian JP. Mechanisms of anabolic therapies for osteoporosis. N Engl J Med. 2007; 357(9):905-16. doi:10.1056/NEJMra067395.
  4. Black DM, Geiger EJ, Eastell R, et al. Atypical Femur Fracture Risk versus Fragility Fracture Prevention with Bisphosphonates. N Engl J Med. 2020; 383(8):743-753. doi:10.1056/NEJMoa1916525.
  5. Tomé-Bermejo F, Piñera AR, Alvarez L. Osteoporosis and the management of spinal degenerative disease (II). Arch Bone Jt Surg. 2017; 5(6):363.
  6. Tomé-Bermejo F, Piñera AR, Alvarez-Galovich L. Osteoporosis and the management of spinal degenerative disease (I). Arch Bone Jt Surg. 2017; 5(5):272.
  7. Kirazlı Y, Atamaz Çalış F, El Ö, et al. Updated approach for the management of osteoporosis in Turkey: a consensus report. Arch Osteoporos. 2020; 15(1):137. doi:10.1007/s11657-020-00799-0.
  8. Aibar-Almazán A, Voltes-Martínez A, Castellote-Caballero Y. Current Status of the Diagnosis and Management of Osteoporosis. Int J Mol Sci. 2022; 23(16):9465. doi:10.3390/ijms23169465.
  9. Dempster DW, Cosman F, Kurland ES, et al. Effects of daily treatment with parathyroid hormone on bone microarchitecture and turnover in patients with osteoporosis: a paired biopsy study. J Bone Miner Res. 2001; 16(10):1846-1853. doi:10.1359/jbmr.2001.16.10.1846.
  10. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of Parathyroid Hormone (1-34) on Fractures and Bone Mineral Density in Postmenopausal Women with Osteoporosis. N Engl J Med. 2001; 344(19):1434-41. doi: 10.1056/NEJM200105103441904.
  1. Li M, Zhang Z, Xue Q, et al. Efficacy of generic teriparatide and alendronate in Chinese postmenopausal women with osteoporosis: a prospective study. Arch Osteoporos. 2022; 17(1):103. doi:10.1007/s11657-022-01131-8.
  2. Roschger P, Rinnerthaler S, Yates J, et al. Alendronate increases degree and uniformity of mineralization in cancellous bone and decreases the porosity in cortical bone of osteoporotic women. Bone. 2001; 29(2):185-91. doi:10.1016/s8756-3282(01)00485-9.
  3. Ryder KM, Tanner SB, Carbone L, et al. Teriparatide is safe and effectively increases bone biomarkers in institutionalized individuals with osteoporosis. J Bone Miner Metab. 2010; 28(2):233-9. doi:10.1007/s00774-009-0123-1.
  4. Sistla D, Mehrotra N, Mon SY. SAT-505 a rare case of teriparatide induced persistent hypercalcemia. Journal of the Endocrine Society. 2019; 3(Supplement_1): SAT-505. doi:10.1210/js.2019-SAT-505.
  5. Karatoprak C, Kayatas K, Kilicaslan H, et al. Severe hypercalcemia due to teriparatide. Indian J Pharmacol. 2012; 44(2):270-1. doi:10.4103/0253-7613.93869.
  6. Ayasreh N, Fernandez-Llama P, Lloret MJ, Da Silva I, Ballarín J, Bover J. Recombinant PTH associated with hypercalcaemia and renal failure. Clinical kidney journal. 2013; 6(1):93-5. doi:10.1093/ckj/sfs148.
  7. Hajime M, Okada Y, Mori H, Tanaka Y. A case of teriparatide-induced severe hypophosphatemia and hypercalcemia. J Bone Miner Metab. 2014; 32(5):601-4. doi:10.1007/s00774-014-0564-z.
  8. Thiruchelvam N, Randhawa J, Sadiek H, Kistangari G. Teriparatide induced delayed persistent hypercalcemia. Case Rep Endocrinol. 2014; 2014:802473. doi:10.1155/2014/802473.
  9. Milosavljevic J, Thomas AM. Teriparatide Associated Late Hypercalcemia: A Report of Two Cases and Literature Review. J Community Hosp Intern Med Perspect. 2022; 12(1):54-58. doi:10.55729/2000-9666.1010.
  10. Canalis E, Giustina A, Bilezikian JP. Mechanisms of anabolic therapies for osteoporosis. N Engl J Med. 2007; 357(9):905-16. doi:10.1056/NEJMra067395.
  11. Eastell R, Rosen CJ, Black DM, et al. Pharmacological Management of Osteoporosis in Postmenopausal Women: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab. 2019; 104(5):1595-1622. doi:10.1210/jc.2019-00221.
The Archives of Bone and Joint Surgery
Volume 13, Issue 3
March 2025
Pages 170-175

  • Receive Date 02 July 2024
  • Revise Date 02 January 2025
  • Accept Date 10 December 2024