{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T17:04:10Z","timestamp":1776359050152,"version":"3.51.2"},"reference-count":9,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,7,3]],"date-time":"2020-07-03T00:00:00Z","timestamp":1593734400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2020,7,3]],"date-time":"2020-07-03T00:00:00Z","timestamp":1593734400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["J Med Case Reports"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n<jats:title>Background<\/jats:title>\n<jats:p>Teriparatide is a homolog of human parathyroid hormone (1\u201334), 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.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Case presentation<\/jats:title>\n<jats:p>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\u2009U\/L (normal range, 80\u2013306). A whole-body bone scan revealed a diffuse increased osseous uptake. Furthermore, the patient\u2019s systemic lupus erythematosus was clinically inactive on the basis of laboratory findings during this period. The medication was discontinued, and the patient\u2019s serum alkaline phosphatase level began to decline.<\/jats:p>\n<\/jats:sec><jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>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\u2019s 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\u00a0in future studies.<\/jats:p>\n<\/jats:sec>","DOI":"10.1186\/s13256-020-02416-7","type":"journal-article","created":{"date-parts":[[2020,7,2]],"date-time":"2020-07-02T23:04:21Z","timestamp":1593731061000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Extremely elevated serum alkaline phosphatase level upon treatment with teriparatide: a case report"],"prefix":"10.1186","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4056-1585","authenticated-orcid":false,"given":"Ali","family":"Javinani","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1754-3450","authenticated-orcid":false,"given":"Hamid Reza","family":"Aghaei Meybodi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4762-6943","authenticated-orcid":false,"given":"Hoda","family":"Kavosi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2020,7,3]]},"reference":[{"issue":"10169","key":"2416_CR1","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1016\/S0140-6736(18)32112-3","volume":"393","author":"JE Compston","year":"2019","unstructured":"Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019;393(10169):364\u201376.","journal-title":"Lancet"},{"issue":"6","key":"2416_CR2","doi-asserted-by":"publisher","first-page":"1041","DOI":"10.1007\/s00198-009-1004-0","volume":"21","author":"V Subbiah","year":"2010","unstructured":"Subbiah V, Madsen VS, Raymond AK, Benjamin RS, Ludwig JA. Of mice and men: divergent risks of teriparatide-induced osteosarcoma. Osteoporosis Int. 2010;21(6):1041\u20135.","journal-title":"Osteoporosis Int"},{"issue":"3","key":"2416_CR3","doi-asserted-by":"publisher","first-page":"617","DOI":"10.2131\/jts.37.617","volume":"37","author":"A Watanabe","year":"2012","unstructured":"Watanabe A, Yoneyama S, Nakajima M, Sato N, Takao-Kawabata R, Isogai Y, et al. Osteosarcoma in Sprague-Dawley rats after long-term treatment with teriparatide (human parathyroid hormone (1-34)). J Toxicol Sci. 2012;37(3):617\u201329.","journal-title":"J Toxicol Sci"},{"issue":"5","key":"2416_CR4","doi-asserted-by":"publisher","first-page":"601","DOI":"10.1007\/s00774-014-0564-z","volume":"32","author":"M Hajime","year":"2014","unstructured":"Hajime M, Okada Y, Mori H, Tanaka Y. A case of teriparatide-induced severe hypophosphatemia and hypercalcemia. J Bone Miner Metab. 2014;32(5):601\u20134.","journal-title":"J Bone Miner Metab"},{"issue":"2","key":"2416_CR5","doi-asserted-by":"publisher","first-page":"R33","DOI":"10.1530\/EJE-17-0920","volume":"178","author":"E Canalis","year":"2018","unstructured":"Canalis E. Management of endocrine disease: novel anabolic treatments for osteoporosis. Eur J Endocrinol. 2018;178(2):R33\u201344.","journal-title":"Eur J Endocrinol"},{"issue":"1\u20132","key":"2416_CR6","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1007\/s11010-011-0856-8","volume":"355","author":"Y Tian","year":"2011","unstructured":"Tian Y, Xu Y, Fu Q, He M. Parathyroid hormone regulates osteoblast differentiation in a Wnt\/\u03b2-catenin-dependent manner. Mol Cell Biochem. 2011;355(1\u20132):211\u20136.","journal-title":"Mol Cell Biochem"},{"issue":"4","key":"2416_CR7","doi-asserted-by":"publisher","first-page":"1245","DOI":"10.1007\/s00198-011-1666-2","volume":"23","author":"P D\u2019Amelio","year":"2012","unstructured":"D\u2019Amelio P, Tamone C, Sassi F, D\u2019Amico L, Roato I, Patane S, et al. Teriparatide increases the maturation of circulating osteoblast precursors. Osteoporosis Int. 2012;23(4):1245\u201353.","journal-title":"Osteoporosis Int"},{"issue":"10","key":"2416_CR8","doi-asserted-by":"publisher","first-page":"2335","DOI":"10.1007\/s00198-018-4604-8","volume":"29","author":"A Gilsenan","year":"2018","unstructured":"Gilsenan A, Harding A, Kellier-Steele N, Harris D, Midkiff K, Andrews E. The Forteo Patient Registry linkage to multiple state cancer registries: study design and results from the first 8 years. Osteoporosis Int. 2018;29(10):2335\u201343.","journal-title":"Osteoporosis Int"},{"issue":"1","key":"2416_CR9","first-page":"12","volume":"31","author":"Food and Drug Administration\u2019s Office of Pediatric Therapeutics and Pediatric and Maternal Health Staff","year":"2010","unstructured":"Food and Drug Administration\u2019s Office of Pediatric Therapeutics and Pediatric and Maternal Health Staff. Forteo not indicated in children with open epiphyses. AAP News. 2010;31(1):12.","journal-title":"AAP News"}],"container-title":["Journal of Medical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-020-02416-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13256-020-02416-7\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13256-020-02416-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,2]],"date-time":"2021-07-02T23:18:19Z","timestamp":1625267899000},"score":1,"resource":{"primary":{"URL":"https:\/\/jmedicalcasereports.biomedcentral.com\/articles\/10.1186\/s13256-020-02416-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,7,3]]},"references-count":9,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["2416"],"URL":"https:\/\/doi.org\/10.1186\/s13256-020-02416-7","relation":{},"ISSN":["1752-1947"],"issn-type":[{"value":"1752-1947","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,7,3]]},"assertion":[{"value":"17 August 2019","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 May 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"3 July 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"Written informed consent was obtained from the patient to publish his data.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"87"}}