Application of teriparatide in CKD-related osteoporosis: efficacy and safety considerations

The efficacy and safety of teriparatide in treating osteoporosis associated with chronic kidney disease (CKD) exhibit variability. Vetrano et al. demonstrated that teriparatide can improve bone density in renal transplant recipients with low bone turnover, with a favorable safety profile. In contrast, Hara et al. found that alendronate was more effective in preventing fractures in patients with CKD stages 3b/4. This discrepancy may be linked to CKD staging and the degree of bone metabolic disturbances. Responses in bone turnover markers are also inconsistent. In advanced CKD patients, the increase in bone resorption markers is limited. The risk of hypercalcemia (22.2%) is associated with the patient's calcium-phosphate metabolism status and parathyroid function. Future research should incorporate bone biopsy and multicenter studies to clarify the efficacy differences across CKD stages and bone turnover types, optimizing individualized application strategies.