Teriparatide successfully treats long-bone Brown tumor in ESRD patient, promoting bone remodeling

End-stage renal disease (ESRD) often leads to secondary hyperparathyroidism (SHPT), which can progress to tertiary hyperparathyroidism characterized by autonomous parathyroid gland function. This severe hormonal imbalance can cause significant bone pathology, including Brown tumors—osteolytic lesions resulting from excessive osteoclastic activity. These tumors can lead to pathological fractures, particularly in long bones, posing complex treatment challenges. Current management often involves calcimimetics like cinacalcet or parathyroidectomy, but these can be insufficient or lead to complications such as hungry bone syndrome and high surgical risks in compromised patients.

This case report details a 32-year-old man with ESRD due to anti-neutrophil cytoplasmic antibody-associated vasculitis and tertiary hyperparathyroidism. He presented with progressive right hip pain, diagnosed as a Brown tumor via biopsy, complicated by a pathological right hip fracture following parathyroidectomy and hungry bone syndrome. Given his ESRD and the fracture pattern, surgical fixation and prosthetic replacement were deemed high-risk due to potential implant failure and infection. Consequently, Teriparatide was initiated to stimulate bone remodeling and facilitate healing, representing a non-surgical therapeutic approach.

Following the initiation of Teriparatide treatment, the patient experienced notable clinical improvements. The primary observation was significant pain relief in the affected right hip, indicating a positive symptomatic response to the therapy. Concurrently, serial radiographic assessments demonstrated clear improvement in the Brown tumor and the associated pathological hip fracture. This radiographic evidence suggested successful bone remodeling and healing, allowing for the deferral of high-risk surgical interventions. The abstract highlights:

To our knowledge, this is the first reported long-bone Brown tumor successfully treated with teriparatide. This outcome underscores Teriparatide's potential to address complex bone lesions in patients with severe underlying conditions, particularly when conventional surgical options are contraindicated or carry excessive risk. The treatment effectively mitigated the progression of bone destruction and promoted reparative processes.