PDF(Pubmed)
Abstract：
UNASSIGNED: Teriparatide, an osteoanabolic agent similar to parathyroid hormone in properties, is used to manage severe osteoporosis. Aortic valve stenosis is a common valve condition observed in the elderly. Its natural history includes gradual progression toward severity. We present a case of a patient who had rapidly progressive aortic stenosis after teriparatide initiation.
UNASSIGNED: An 84-year-old woman who was diagnosed with osteoporosis was treated with oral bisphosphonates. When she had spinal compression fractures, she was found to have primary hyperparathyroidism. She underwent parathyroidectomy and was treated with denosumab infusions every 6 months. However, after she experienced bilateral atypical femoral fractures, she was switched to teriparatide daily injections. Her laboratory test results showed a calcium level of 10 mg/dL (reference range, 8.5-10.2 mg/dL), 25-hydroxyvitamin D level of 38.2 ng/mL (reference range, 31.0-80.0 ng/mL), and phosphorus level of 3.3 mg/dL (reference, range, 2.7-4.8 mg/dL). On reviewing echocardiograms before and after teriparatide initiation, we found a rapid progression of her aortic stenosis from moderate to severe based on the mean gradients (23 to 40 mm Hg) and peak velocities (3.09 to 4 m/s), over a span of 10 months. She eventually required valve replacement.
UNASSIGNED: Natural progression of mild to severe aortic stenosis typically occurs at the rate of 3 to 7 mm Hg per year over several years. Chronic exposure of human valvular endothelial cells to parathyroid hormone can trigger endothelial dysfunction and valvular calcification.
UNASSIGNED: In patients with preexisting aortic stenosis, coordination of care with cardiology and echocardiographic monitoring while on therapy may be considered.
UNASSIGNED: An 84-year-old woman who was diagnosed with osteoporosis was treated with oral bisphosphonates. When she had spinal compression fractures, she was found to have primary hyperparathyroidism. She underwent parathyroidectomy and was treated with denosumab infusions every 6 months. However, after she experienced bilateral atypical femoral fractures, she was switched to teriparatide daily injections. Her laboratory test results showed a calcium level of 10 mg/dL (reference range, 8.5-10.2 mg/dL), 25-hydroxyvitamin D level of 38.2 ng/mL (reference range, 31.0-80.0 ng/mL), and phosphorus level of 3.3 mg/dL (reference, range, 2.7-4.8 mg/dL). On reviewing echocardiograms before and after teriparatide initiation, we found a rapid progression of her aortic stenosis from moderate to severe based on the mean gradients (23 to 40 mm Hg) and peak velocities (3.09 to 4 m/s), over a span of 10 months. She eventually required valve replacement.
UNASSIGNED: Natural progression of mild to severe aortic stenosis typically occurs at the rate of 3 to 7 mm Hg per year over several years. Chronic exposure of human valvular endothelial cells to parathyroid hormone can trigger endothelial dysfunction and valvular calcification.
UNASSIGNED: In patients with preexisting aortic stenosis, coordination of care with cardiology and echocardiographic monitoring while on therapy may be considered.
摘要：
■特立帕肽，一种性质类似于甲状旁腺激素的骨合成代谢剂，用于治疗严重的骨质疏松症.主动脉瓣狭窄是在老年人中观察到的常见瓣膜状况。它的自然史包括逐渐走向严重。我们介绍了一例特立帕肽开始后出现快速进行性主动脉瓣狭窄的患者。
■一名84岁女性被诊断患有骨质疏松症，接受口服双膦酸盐治疗。当她患有脊柱压缩性骨折时，她被发现患有原发性甲状旁腺功能亢进。她接受了甲状旁腺切除术，每6个月接受一次denosumab输液治疗。然而,在她经历了双侧非典型股骨骨折后，她改用特立帕肽每日注射.她的实验室测试结果显示钙水平为10毫克/分升(参考范围，8.5-10.2mg/dL)，25-羟基维生素D水平为38.2ng/mL(参考范围，31.0-80.0ng/mL)，和磷水平为3.3毫克/分升(参考，范围,2.7-4.8mg/dL）。在观察特立帕肽开始之前和之后的超声心动图时，我们发现，根据平均梯度（23至40mmHg）和峰值速度（3.09至4m/s），她的主动脉瓣狭窄从中度到重度迅速发展。超过10个月。她最终需要更换瓣膜。
轻度至重度主动脉瓣狭窄的自然进展通常在几年内以每年3至7mmHg的速度发生。人瓣膜内皮细胞慢性暴露于甲状旁腺激素可引发内皮功能障碍和瓣膜钙化。
■在已有主动脉瓣狭窄的患者中，在治疗期间,可考虑协调治疗与心脏病学和超声心动图监测.
■一名84岁女性被诊断患有骨质疏松症，接受口服双膦酸盐治疗。当她患有脊柱压缩性骨折时，她被发现患有原发性甲状旁腺功能亢进。她接受了甲状旁腺切除术，每6个月接受一次denosumab输液治疗。然而,在她经历了双侧非典型股骨骨折后，她改用特立帕肽每日注射.她的实验室测试结果显示钙水平为10毫克/分升(参考范围，8.5-10.2mg/dL)，25-羟基维生素D水平为38.2ng/mL(参考范围，31.0-80.0ng/mL)，和磷水平为3.3毫克/分升(参考，范围,2.7-4.8mg/dL）。在观察特立帕肽开始之前和之后的超声心动图时，我们发现，根据平均梯度（23至40mmHg）和峰值速度（3.09至4m/s），她的主动脉瓣狭窄从中度到重度迅速发展。超过10个月。她最终需要更换瓣膜。
轻度至重度主动脉瓣狭窄的自然进展通常在几年内以每年3至7mmHg的速度发生。人瓣膜内皮细胞慢性暴露于甲状旁腺激素可引发内皮功能障碍和瓣膜钙化。
■在已有主动脉瓣狭窄的患者中，在治疗期间,可考虑协调治疗与心脏病学和超声心动图监测.
