Parathyroid hormone and teriparatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use.
Anthony B. Hodsman,Douglas C. Bauer,David W. Dempster,Larry Dian,David A. Hanley,Steven T. Harris,David L. Kendler,Michael R. McClung,Paul D. Miller,Wojciech P. Olszynski,Eric S. Orwoll,Chui Kin Yuen +11 more
TLDR
There is as yet no evidence that the antifracture efficacy of PTH will be superior to the bisphosphonates, whereas cost-utility estimates suggest that teriparatide is significantly more expensive.Abstract:
All therapies currently recommended for the management of osteoporosis act mainly to inhibit bone resorption and reduce bone remodeling. PTH and its analog, teriparatide [recombinant human PTH(1-34)], represent a new class of anabolic therapies for the treatment of severe osteoporosis, having the potential to improve skeletal microarchitecture. Significant reductions in both vertebral and appendicular fracture rates have been demonstrated in the phase III trial of teriparatide, involving elderly women with at least one prevalent vertebral fracture before the onset of therapy. However, there is as yet no evidence that the antifracture efficacy of PTH will be superior to the bisphosphonates, whereas cost-utility estimates suggest that teriparatide is significantly more expensive. Teriparatide should be considered as treatment for postmenopausal women and men with severe osteoporosis, as well as for patients with established glucocorticoid-induced osteoporosis who require long-term steroid treatment. Teriparatide should also be considered for the management of individuals at particularly high risk for fractures, including subjects who are younger than age 65 and who have particularly low bone mineral density measurements (T scores < or = 3.5). Teriparatide therapy is not recommended for more than 2 yr, based, in part, on the induction of osteosarcoma in a rat model of carcinogenicity. Total daily calcium intake from both supplements and dietary sources should be limited to 1500 mg together with adequate vitamin D intake (< or =1000 U/d). Monitoring of serum calcium may be safely limited to measurement after 1 month of treatment; mild hypercalcemia may be treated by withdrawing dietary calcium supplements, reducing the dosing frequency of PTH, or both. At present, concurrent therapy with antiresorptive therapy, particularly bisphosphonates, should be avoided, although sequential therapy with such agents may consolidate the beneficial effects upon the skeleton after PTH is discontinued.read more
Citations
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Molecular and cellular mechanisms of the anabolic effect of intermittent PTH.
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Glucocorticoid-induced osteoporosis: an update.
TL;DR: The gold standard in the pharmacological treatment of glucocorticoid-induced osteoporosis in postmenopausal women involves the use of bisphosphonates, which should be started soon after beginning chronic glucoc Corticoid therapy.
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Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis.
Robert M. Neer,Claude D. Arnaud,Jose R. Zanchetta,Richard L. Prince,Gregory A Gaich,Jean-Yves Reginster,Anthony B. Hodsman,Erik Fink Eriksen,Sophia Ish-Shalom,Harry K. Genant,Ouhong Wang,Bruce H. Mitlak +11 more
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Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial
Bruce Ettinger,Dennis M. Black,Bruce H. Mitlak,Ronald Keith Knickerbocker,Thomas Nickelsen,Harry K. Genant,Claus Christiansen,Pierre D. Delmas,Jose R. Zanchetta,J. A. Stakkestad,Claus C. Glüer,Kathryn A. Krueger,Fredric J. Cohen,Stephen Eckert,Kristine E. Ensrud,Louis V. Avioli,Paul Lips,Steven R. Cummings +17 more
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Effects of Risedronate Treatment on Vertebral and Nonvertebral Fractures in Women With Postmenopausal Osteoporosis: A Randomized Controlled Trial
Steven T. Harris,Nelson B. Watts,Harry K. Genant,Clark D. McKeever,Thomas N. Hangartner,Michael Keller,Charles H. Chesnut,Jacques P. Brown,Erik Fink Eriksen,Mohammad S. Hoseyni,Douglas Wayne Axelrod,Paul D. Miller +11 more
TL;DR: Risedronate, a potent bisphosphonate, has been shown to be effective in the treatment of Paget disease of bone and other metabolic bone diseases, but, to the knowledge, it has not been evaluated in this article.
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