Evidence summary of anabolic PTH agents (teriparatide) on bone mineral density in patients with advanced kidney disease

A systematic review included two randomized controlled trials and showed an association between teriparatide and improvements in bone mineral density, but the evidence and safety data remain insufficient and more research is needed to clarify clinical benefits and risks.[1]

Study type: Journal Article, Systematic Review (category: Clinical guideline / High-quality systematic review) Published: Basic & clinical pharmacology & toxicology, 2026-11-11 Source: PubMed public abstract

A systematic review included two randomized controlled trials and showed an association between teriparatide and improvements in bone mineral density, but the evidence and safety data remain insufficient and more research is needed to clarify clinical benefits and risks.[1]

Why this study matters

Patients with chronic kidney disease (CKD), especially advanced stages (Stage 4–5D), have increased fracture risk, but evidence on the efficacy and safety of anti-osteoporosis drugs in this population is relatively sparse. This systematic review searched for randomized controlled trials of anabolic parathyroid hormone (PTH) agents (teriparatide, parathyroid hormone (1-84), abaloparatide) in adults with CKD Stage 4–5D (including dialysis and kidney transplant recipients). The primary outcomes were changes in bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip; secondary outcomes included bone turnover markers, fractures, bone biopsy findings, and adverse events. The review searched MEDLINE, EMBASE, and ClinicalTrials.gov.[1]

What the study actually found

The review included only two randomized controlled trials. Key observations were:

• In one trial that included a CKD Stage 4 subgroup (n = 5), teriparatide was associated with improvements in lumbar spine (LS) and femoral neck (FN) BMD.[1]
• Another trial in CKD Stage 5D (n = 61) reported that teriparatide was associated with a significant improvement in total hip (TH) BMD compared with the control group.[1]
• The teriparatide group experienced more adverse events (AEs).[1]

Overall, the authors noted that teriparatide appears to be associated with BMD improvements, but the available evidence is limited and safety data are insufficient to draw definitive conclusions.[1]

Possible implications for patients with CKD, on dialysis, or with a transplant

The associations reported suggest:

• For some patients with advanced CKD, teriparatide may be associated with short-term increases in BMD, but this is not established as a causal effect, and the relevant evidence comes from a small number of trials with small sample sizes.[1]
• Current evidence is insufficient to consider teriparatide or other anabolic PTH agents as standard therapy or as a replacement for existing treatments in patients with advanced CKD. Clinical regimens, long-term effects (such as fracture reduction), and safety risks require more data.

For patients and care teams, the practical implication is that if considering anabolic therapy, this should be done under physician assessment, weighing potential short-term BMD benefits against the risk of adverse events, and recognizing that net clinical benefit in this population has not been well established.[1]

Limitations of the current research

Major limitations reported in the review abstract include:

• The review included only two RCTs, indicating a very limited number of available trials, and most samples were small (for example, CKD Stage 4 subgroup n = 5), limiting the stability and generalizability of results.[1]
• The abstract did not provide complete data on fracture endpoints, long-term follow-up, or detailed distribution of adverse events, preventing conclusions about clinical endpoints (such as fracture reduction) or long-term safety.[1]
• The review examined RCTs of only teriparatide, parathyroid hormone (1-84), and abaloparatide; in practice, only teriparatide produced relevant reported results, so benefits and risks of the other agents remain unclear.[1]
• This summary is based on the PubMed public abstract; the full text was not reviewed, so this summary is limited to information available in the abstract and could not assess full methodological details or supplemental results.

Conclusions that remain uncertain

Unresolved or unclear issues include:

• Whether short-term increases in BMD translate into clinically meaningful reductions in fractures remains unknown.
• Long-term safety, tolerability, and durability of benefit after stopping teriparatide in advanced CKD (including dialysis patients and transplant recipients) are unclear.
• It is unknown whether all patients with advanced CKD (with different bone pathology types) respond similarly to anabolic therapy; renal bone disease pathophysiology may influence efficacy and risk.
• Clinical trial data for other anabolic PTH agents (parathyroid hormone (1-84), abaloparatide) in CKD Stage 4–5D are insufficient to compare efficacy or safety between agents.[1]
• Because so few trials were included, results from any single study should not be taken as consensus, and animal or cellular studies cannot be directly applied to human clinical decision-making.

Questions to discuss with your medical team

• Are the results of this review applicable to my CKD stage and individual circumstances? (Discuss with a nephrologist or an orthopedic/endocrine bone specialist)
• Will teriparatide’s BMD improvement actually reduce my fracture risk? Are there long-term follow-up data?
• What common or important adverse events occur with teriparatide in dialysis or transplant patients?
• Are there other treatments with established safety and efficacy for patients with advanced CKD?
• Are there ongoing or planned clinical trials that could provide more evidence?

How to read this study (our interpretation)

This section was written by the Beyond CKD editor — a kidney-transplant recipient with a health-management background, not a physician — using only the PubMed abstract. We have not read the full paper, and no clinician has reviewed this text. It is meant to help you understand the numbers, not to advise treatment.

What the study asked

People with stage 4–5 CKD or on dialysis have a high fracture risk, yet most osteoporosis trials exclude them. This systematic review looked for randomised trials of bone-building (“anabolic”) drugs — parathyroid-hormone analogues such as teriparatide and abaloparatide — in CKD stages 4–5D, including transplant recipients, with outcomes of bone density, turnover markers, fractures and adverse events.

How to read the results

More than 2,500 papers were screened and only 2 randomised trials qualified — that number is the headline finding: the evidence barely exists. In one trial, a stage-4 CKD subgroup of just 5 people showed teriparatide improved lumbar-spine and femoral-neck density; in the other, 61 dialysis patients showed significantly better total-hip density than controls. Adverse events were more frequent with teriparatide. The authors conclude it “seems to improve BMD” but that evidence on efficacy and safety is limited. Remember that higher bone density is a surrogate; it does not by itself show fewer fractures.

Limitations

Two trials with fewer than 70 people in total, one subgroup of 5 — no stable conclusion is possible. The abstract reports no fracture counts, biopsy findings or specific adverse-event types. The type of renal bone disease (high- or low-turnover, adynamic bone) affects whether these drugs are appropriate, and the abstract does not say how the trials handled it.

What it means for readers and people with kidney disease

For people with advanced CKD, on dialysis or after transplant, this review is honest: the evidence for anabolic bone drugs in your situation is very thin, and any recommendation to use them rests on individual judgement and limited data rather than established guidance. It also underlines that your fracture risk is real but under-researched — a point worth raising with your team.

How to check further

Ask your doctor: What type of bone disease do my density scan and turnover markers (PTH, alkaline phosphatase) suggest? Would a bone biopsy help? Which osteoporosis drugs are usable at my kidney function?

Original abstract: PubMed 42825520 (https://pubmed.ncbi.nlm.nih.gov/42825520/). Interpretation last updated 2026-11-06.

References

[1] Kafa HS, Hauge SC, Hansen D. Bone Anabolic Treatment in Patients With Chronic Kidney Disease: A Systematic Review.. Basic & clinical pharmacology & toxicology. 2026. DOI: 10.1111/bcpt.70293. PMID: 42825520.

Medical disclaimer: This article is for general health education and information only. It does not constitute individual medical diagnosis, treatment advice, or a doctor–patient relationship. Medical research is continually updated, and study findings have their own scope and limitations. Every patient's condition, laboratory values, medications and treatment needs differ. Do not stop or adjust medication doses, change your diet or fluid intake, or alter dialysis or transplant treatment based on this article alone. For any medical questions, please consult your nephrologist or another qualified healthcare professional.

Article created: 2026-10-31 | Original study published: 2026-11-11 | Last checked: 2026-10-31 (source metadata verified against PubMed)