Extremely elevated serum alkaline phosphatase level upon treatment with teriparatide: a case report
Abstract Background Teriparatide is a homolog of human parathyroid hormone (1–34), which is approved for the treatment of postmenopausal and glucocorticoid-induced osteoporosis. Several minor and transient side effects have been reported for teriparatide. However, controversial findings showed an in...
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| Format: | Article |
| Language: | English |
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BMC
2020-07-01
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| Series: | Journal of Medical Case Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s13256-020-02416-7 |
| _version_ | 1818108864140148736 |
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| author | Ali Javinani Hamid Reza Aghaei Meybodi Hoda Kavosi |
| author_facet | Ali Javinani Hamid Reza Aghaei Meybodi Hoda Kavosi |
| author_sort | Ali Javinani |
| collection | DOAJ |
| description | Abstract Background Teriparatide is a homolog of human parathyroid hormone (1–34), which is approved for the treatment of postmenopausal and glucocorticoid-induced osteoporosis. Several minor and transient side effects have been reported for teriparatide. However, controversial findings showed an increased risk of more significant adverse effects, including osteosarcoma in humans, although this finding has been demonstrated primarily in murine models. Case presentation We present a case of a 22-year-old Persian man with a previous history of systemic lupus erythematosus and glucocorticoid-induced osteoporosis. He had a previous history of joint hypermobility, idiopathic kyphoscoliosis, mitral valve prolapse, and bilateral congenital inguinal hernia, which were probably compatible with an inherited connective tissue disease. He was treated with teriparatide for 7 months because of glucocorticoid-induced osteoporosis. He was referred with a complaint of generalized bone pain and an extremely elevated serum alkaline phosphatase concentration of 6480 U/L (normal range, 80–306). A whole-body bone scan revealed a diffuse increased osseous uptake. Furthermore, the patient’s systemic lupus erythematosus was clinically inactive on the basis of laboratory findings during this period. The medication was discontinued, and the patient’s serum alkaline phosphatase level began to decline. Conclusions To the best of our knowledge, this is the first case of an osteoblast hyperactivation state observed during treatment with teriparatide. It appears that the osteoblastogenic effect of teriparatide might induce this condition and, most likely, osteosarcoma in certain populations. However, the potential influence of the patient’s young age, systemic lupus erythematosus, underlying inherited connective tissue disease, and medication use cannot be ignored. The potential risk factors of this side effect shall be studied in specific subpopulations of patients with osteoporosis in future studies. |
| first_indexed | 2024-12-11T02:22:08Z |
| format | Article |
| id | doaj.art-86c830b0c4cc430b8e55f68a4cc7b6d4 |
| institution | Directory Open Access Journal |
| issn | 1752-1947 |
| language | English |
| last_indexed | 2024-12-11T02:22:08Z |
| publishDate | 2020-07-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Medical Case Reports |
| spelling | doaj.art-86c830b0c4cc430b8e55f68a4cc7b6d42022-12-22T01:24:01ZengBMCJournal of Medical Case Reports1752-19472020-07-011411510.1186/s13256-020-02416-7Extremely elevated serum alkaline phosphatase level upon treatment with teriparatide: a case reportAli Javinani0Hamid Reza Aghaei Meybodi1Hoda Kavosi2Rheumatology Research Center, Tehran University of Medical Sciences (TUMS)Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Research Institute, Tehran University of Medical SciencesRheumatology Research Center, Tehran University of Medical Sciences (TUMS)Abstract Background Teriparatide is a homolog of human parathyroid hormone (1–34), which is approved for the treatment of postmenopausal and glucocorticoid-induced osteoporosis. Several minor and transient side effects have been reported for teriparatide. However, controversial findings showed an increased risk of more significant adverse effects, including osteosarcoma in humans, although this finding has been demonstrated primarily in murine models. Case presentation We present a case of a 22-year-old Persian man with a previous history of systemic lupus erythematosus and glucocorticoid-induced osteoporosis. He had a previous history of joint hypermobility, idiopathic kyphoscoliosis, mitral valve prolapse, and bilateral congenital inguinal hernia, which were probably compatible with an inherited connective tissue disease. He was treated with teriparatide for 7 months because of glucocorticoid-induced osteoporosis. He was referred with a complaint of generalized bone pain and an extremely elevated serum alkaline phosphatase concentration of 6480 U/L (normal range, 80–306). A whole-body bone scan revealed a diffuse increased osseous uptake. Furthermore, the patient’s systemic lupus erythematosus was clinically inactive on the basis of laboratory findings during this period. The medication was discontinued, and the patient’s serum alkaline phosphatase level began to decline. Conclusions To the best of our knowledge, this is the first case of an osteoblast hyperactivation state observed during treatment with teriparatide. It appears that the osteoblastogenic effect of teriparatide might induce this condition and, most likely, osteosarcoma in certain populations. However, the potential influence of the patient’s young age, systemic lupus erythematosus, underlying inherited connective tissue disease, and medication use cannot be ignored. The potential risk factors of this side effect shall be studied in specific subpopulations of patients with osteoporosis in future studies.http://link.springer.com/article/10.1186/s13256-020-02416-7Glucocorticoid-induced osteoporosisSystemic lupus erythematosusTeriparatide |
| spellingShingle | Ali Javinani Hamid Reza Aghaei Meybodi Hoda Kavosi Extremely elevated serum alkaline phosphatase level upon treatment with teriparatide: a case report Journal of Medical Case Reports Glucocorticoid-induced osteoporosis Systemic lupus erythematosus Teriparatide |
| title | Extremely elevated serum alkaline phosphatase level upon treatment with teriparatide: a case report |
| title_full | Extremely elevated serum alkaline phosphatase level upon treatment with teriparatide: a case report |
| title_fullStr | Extremely elevated serum alkaline phosphatase level upon treatment with teriparatide: a case report |
| title_full_unstemmed | Extremely elevated serum alkaline phosphatase level upon treatment with teriparatide: a case report |
| title_short | Extremely elevated serum alkaline phosphatase level upon treatment with teriparatide: a case report |
| title_sort | extremely elevated serum alkaline phosphatase level upon treatment with teriparatide a case report |
| topic | Glucocorticoid-induced osteoporosis Systemic lupus erythematosus Teriparatide |
| url | http://link.springer.com/article/10.1186/s13256-020-02416-7 |
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