Teriparatide treatment of osteoporosis in solid organ transplant recipients-a single-center experience.

UNLABELLED: Solid organ transplant recipients face high fracture risk with limited evidence guiding anabolic therapy. In this real-world cohort, teriparatide was associated with significant improvements in bone mineral density and acceptable safety without adverse graft effects. These findings support selective anabolic treatment in high-risk transplant recipients and highlight the need for prospective studies. PURPOSE: Solid organ transplant (SOT) recipients are at high risk for osteoporosis and fragility fractures due to pre-existing organ dysfunction and long-term immunosuppressive therapy, particularly glucocorticoids. However, evidence supporting the use of anabolic osteoporosis therapy in this population remains limited. METHODS: We conducted a retrospective cohort study at a large transplant center including adult kidney, lung, and liver transplant recipients selected for teriparatide treatment based on clinical indications for severe post-transplant osteoporosis for at least 3 months. Bone mineral density (BMD), incident fractures, biochemical parameters, renal function, and adverse events were evaluated during treatment and follow-up. RESULTS: Thirty-nine SOT recipients (33% men; mean age 61.3 ± 11.6 years) were included, comprising kidney (n = 10), lung (n = 20), and liver (n = 9) transplant recipients. Prior fragility fractures were present in 90% of patients, and 79% had multiple fractures. Median teriparatide treatment duration was 22.3 months. Significant increases in BMD were observed at the lumbar spine (+11 ± 15%, p = 0.01), femoral neck (+8 ± 14%, p = 0.05), and total hip (+11 ± 16%, p = 0.05). Six patients sustained fractures after teriparatide initiation; only two occurred during active therapy, whereas four occurred after treatment discontinuation. Hypercalcemia occurred in one patient and led to treatment cessation. The estimated glomerular filtration rate declined modestly during the first 6 months and stabilized thereafter; a broadly similar pattern was observed in contemporaneous matched transplant controls. No episodes of graft rejection were observed. CONCLUSIONS: In this real-world cohort of SOT recipients with severe osteoporosis, teriparatide therapy was associated with significant improvements in BMD, acceptable safety, and no apparent excess risk to graft function. These findings support the selective use of anabolic therapy in high-risk transplant recipients and highlight the need for prospective studies to define optimal treatment strategies.