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Preparing your E-Poster
Please review the E-Poster format requirements carefully when preparing your E-Poster. Should your E-Poster not meet the mentioned requirements, it may not be displayed as described above.
E-Poster Submission Deadline
Please prepare and upload your E-Poster no later than March 14, 2026 11.59PM CET. After this date, you will no longer be able to prepare and upload your E-poster and it will not be displayed and accessible on the congress website.
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Abstract titles should be brief and reflect the content of the abstract.
Patients with chronic kidney disease (CKD), particularly those undergoing hemodialysis (HD), are at increased risk of bone fractures, primarily due to CKD-mineral and bone disorder (CKD-MBD). Although secondary hyperparathyroidism (SHPT) can be managed using vitamin D analogs and calcimimetics, fracture risk remains elevated, highlighting the need for direct therapeutic interventions targeting bone density and quality. Unlike in the general population, treatment for osteoporosis has not yet been established for HD patients. Teriparatide, a recombinant human parathyroid hormone (PTH 1–34), has shown potential to improve bone mineral density (BMD) in HD patients with low PTH levels. However, previous studies using once-weekly formulations reported adverse events, including transient hypotension and high dropout rates, limiting the accumulation of robust evidence in this population. In contrast, the twice-weekly teriparatide autoinjector formulation has demonstrated improved adherence and ultimately a reduced incidence of adverse effects compared to the once-weekly formulation in patients with primary osteoporosis. The higher tolerability could lead to the better maintenance of bone density over time. This trial aims to assess the efficacy and safety of twice-weekly teriparatide in HD patients with well-controlled SHPT.
The START-HOP trial is a multicenter, prospective, randomized, open-label, controlled trial designed to evaluate the efficacy and safety of twice-weekly teriparatide (28.2 μg) in HD patients with osteoporosis. Eligible patients meeting the criteria for participation will be randomized (1:1) to either the teriparatide group or the control group (delayed-start teriparatide) (Figure 1). We set a target of 25 participants in each group (a total of 50) based on sample size calculations from a previous report. Randomization is performed using a web-based system, wherein patients are stratified by age, intact parathyroid hormone (iPTH) levels and percent Young Adult Mean(%YAM). The primary analysis will compare the percentage change in lumbar spine BMD after a 48-week period (Figure 1-1). Following the initial 48 weeks, participants in the teriparatide group will discontinue the medication, while those in the control group will start receiving teriparatide for an additional 48 weeks. Within-group analyses will be conducted to assess changes before and after teriparatide administration in all participants over a 48-week treatment period (Figure 1-2).
To date, 38 patients have been randomly assigned to two groups (19 subjects to teriparatide and 19 to control). Baseline characteristics are well balanced between the two groups (Table 1). No substantial differences have been observed at enrollment. Data analysis is ongoing, and efficacy and safety outcomes will be reported after completion of the planned observation period.
This trial is the first randomized controlled study to evaluate the efficacy and safety of a twice-weekly 28.2µg teriparatide regimen in HD patients with osteoporosis and well-controlled SHPT. By presenting both the study protocol and current enrollment status, we aim to provide a foundation for evidence-based strategies to improve bone health in this high-risk population.
