Parathyroid Hormone for the Prevention and Treatment of Postmenopausal Osteoporosis: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

CHU Jiacheng ¹ , LI Jian ¹ ,  OUYANG Lingli ¹ , WU Taixiang ²

1.The First Affiliated Hospital of Guangxi Medical University, Nanning 530021, China;2.Chinese Evidence-Based Medicine Centre, Chinese Clinical Trial Register, INCLEN CERTC, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

OUYANG Lingli, Email: ouyanglli@yahoo.com.cn

Keywords：

Parathyroid hormone; Osteoporosis; Postmenopausal; Systematic review

DOI：

10.7507/1672-2531.20080194

Video：

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Objective 　To assess the efficacy and safety of parathyroid hormone (PTH) on bone mineral density (BMD) and fractures in postmenopausal women with osteoporosis.
Methods 　We searched MEDLINE (1966 to March 2008), EMBASE (1974 to March 2008), The Cochrane Library (Issue 1, 2008), Current Controlled Trials, The National Research Register, CBM (1983 to March 2008) and CNKI (1994 to March 2008). Some related journals were hand searched as well. The quality of included randomized controlled trials (RCTs) was evaluated and meta-analysis was conducted by The Cochrane Collaboration’s software RevMan 4.2.10.
Results 　Twelve studies involving 5550 patients were included. PTH alone or in combination with antiresorptive drugs reduced the risk of vertebral fracture (RR=0.34, 95%CI 0.26 to 0.45, P lt;0.000 01), and increased spine BMD (SMD 0.41, 95%CI 0.17 to 0.65, P=0.0009) and femoral neck BMD (SMD 0.13, 95%CI 0.03 to 0.22, P=0.008). The rate of drop out and loss to follow-up because of adverse events was significantly higher in the PTH group (Peto-OR=1.69, 95%CI 1.39 to 2.05, P lt;0.000 01).
Conclusion 　 PTH is effective in the prevention and treatment of postmenopausal osteoporosis, especially in patients with preexisting osteoporotic fractures or with very low bone density. PTH alone or in combination with antiresorptive drugs can reduce the risk of vertebral fractures and increase spine and femoral neck BMD. PTH is more effective than alendronate, but these two should not be used as a combined treatment.

Citation： CHU Jiacheng,LI Jian,OUYANG Lingli,WU Taixiang. Parathyroid Hormone for the Prevention and Treatment of Postmenopausal Osteoporosis: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2008, 08(10): 879-886. doi: 10.7507/1672-2531.20080194 Copy

1.	Moayyeri A, Soltani A, Bahrami H, et al. Preferred skeletal site for osteoporosis screening in high-risk populations. public health, 2006, 120(9): 863-871.
2.	Report of a WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report Series, 1994, 843.
3.	Kanis JA, Melton LJⅢ, Christiansea C, et al. The diagnosis of osteoporosis. J Bone Miner Res, 1994, 9: 1137-1141.
4.	Report of a WHO Scientific Group. Prevention and Management of Osteoporosis. WHO Technical Report Series, 2003, 921.
5.	WANG Hong-fu. Diagnosis of osteoporosis. Intern J Endocrinol Metab, 2006, 26: 285-288.(in chinese).
6.	Doggrell SA. Recent important clinical trials of drugs in osteoporosis. Expert Opin Pharmacother, 2004, 5(7): 1635.
7.	ZHANG Jun, GE Ning, HUANG Xiao-li, et al. Review of drug treatment for osteoporosis. Chinese journal of practical internal medicine, 2006, 26(4): 313-315.(in chinese).
8.	Vestergaard P, Jorgensen N, et al. Effects of parathyroid hormone alone or in combination with antiresorptive therapy on bone mineral density and fracture risk-a meta-analysis. Osteoporos Int, 2007, 18: 45-47.
9.	吴泰相, 刘关键. 隐蔽分组(分配隐藏)和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 222-225.
10.	Black DM, Bouxsein ML, Palermo L, et al. Randomized Trial of Once-Weekly PTH (1-84) on Bone Mineral Density and Remodeling. J Clin Endocrin Metab, 2008, 2007-2781.
11.	Cosman F, Nieves JW, Zion M, et al. Effect of prior and ongoing raloxifene therapy on response to PTH and maintenance of BMD after PTH therapy. Osteoporos Int, 2008, 19(4): 529-535.
12.	Greenspan SL, Bone HG, Ettinger MP, et al. Effect of recombinant human parathyroid hormone (1-84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis: a randomized trial. Ann Intern Med, 2007, 146(5): 326-339.
13.	Gonnelli S, Martini G, Caffarelli C, et al. Teriparatide’s effects on quantitative ultrasound parameters and bone density in women with established osteoporosis. Osteoporos Int, 2006, 17(10): 1524-1531.
14.	Ste-Marie LG, Schwartz SL, Hossain A, et al. Effect of teriparatide [rhPTH(1-34)] on BMD when given to postmenopausal women receiving hormone replacement therapy. J Bone Miner Res, 2006, 21(2): 283-291.
15.	Cosman F, Nieves J, Zion M, et al. Daily and cyclic parathyroid hormone in women receiving alendronate. N Engl J Med, 2005, 353: 566-575.
16.	McClung MR, San Martin J, Miller PD, et al. Opposite bone remodeling effects of teriparatide and alendronate in increasing bone mass. Arch Intern Med, 2005, 165: 1762-1768.
17.	Hodsman AB, Hanley DA, Ettinger MP, et al. Efficacy and safety of human parathyroid hormone-(1-84) in increasing bone mineral density in postmenopausal osteoporosis. J Clin Endocrinol Metab, 2003, 88: 5212-5220.
18.	Black DM, Greenspan SL, Ensrud KE, et al. The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. N Engl J Med, 2003, 349: 1207-1215.
19.	Body JJ, Gaich GA, Scheele WH, et al. A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1-34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab, 2002, 87: 4528-4535.
20.	Cosman F, Nieves J, Woelfert L, et al. Parathyroid hormone added to established hormone therapy: effects on vertebral fracture and maintenance of bone mass after parathyroid hormone withdrawal. J Bone Miner Res, 2001, 16: 925-931.
21.	Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med, 2001, 344: 1434-1441.
22.	Hodsman AB, Bauer DC, Dempster DW, et al. Parathyroid Hormone and Teriparatide for the Treatment of Osteoporosis: A Review of the Evidence and Suggested Guidelines for Its Use. Endocrine Reviews, 2005, 26(5): 688-703.
23.	Vahle JL, Sato M, Long GG, et al. Skeletal changes in rats given daily subcutaneous injections of recombinant human parathyroid hormone(1-34) for 2 years and relevance to human safety. Toxicol Pathol, 2002, 30: 312-321.

1. Moayyeri A, Soltani A, Bahrami H, et al. Preferred skeletal site for osteoporosis screening in high-risk populations. public health, 2006, 120(9): 863-871.
2. Report of a WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report Series, 1994, 843.
3. Kanis JA, Melton LJⅢ, Christiansea C, et al. The diagnosis of osteoporosis. J Bone Miner Res, 1994, 9: 1137-1141.
4. Report of a WHO Scientific Group. Prevention and Management of Osteoporosis. WHO Technical Report Series, 2003, 921.
5. WANG Hong-fu. Diagnosis of osteoporosis. Intern J Endocrinol Metab, 2006, 26: 285-288.(in chinese).
6. Doggrell SA. Recent important clinical trials of drugs in osteoporosis. Expert Opin Pharmacother, 2004, 5(7): 1635.
7. ZHANG Jun, GE Ning, HUANG Xiao-li, et al. Review of drug treatment for osteoporosis. Chinese journal of practical internal medicine, 2006, 26(4): 313-315.(in chinese).
8. Vestergaard P, Jorgensen N, et al. Effects of parathyroid hormone alone or in combination with antiresorptive therapy on bone mineral density and fracture risk-a meta-analysis. Osteoporos Int, 2007, 18: 45-47.
9. 吴泰相, 刘关键. 隐蔽分组(分配隐藏)和盲法的概念、实施与报告. 中国循证医学杂志, 2007, 7(3): 222-225.
10. Black DM, Bouxsein ML, Palermo L, et al. Randomized Trial of Once-Weekly PTH (1-84) on Bone Mineral Density and Remodeling. J Clin Endocrin Metab, 2008, 2007-2781.
11. Cosman F, Nieves JW, Zion M, et al. Effect of prior and ongoing raloxifene therapy on response to PTH and maintenance of BMD after PTH therapy. Osteoporos Int, 2008, 19(4): 529-535.
12. Greenspan SL, Bone HG, Ettinger MP, et al. Effect of recombinant human parathyroid hormone (1-84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis: a randomized trial. Ann Intern Med, 2007, 146(5): 326-339.
13. Gonnelli S, Martini G, Caffarelli C, et al. Teriparatide’s effects on quantitative ultrasound parameters and bone density in women with established osteoporosis. Osteoporos Int, 2006, 17(10): 1524-1531.
14. Ste-Marie LG, Schwartz SL, Hossain A, et al. Effect of teriparatide [rhPTH(1-34)] on BMD when given to postmenopausal women receiving hormone replacement therapy. J Bone Miner Res, 2006, 21(2): 283-291.
15. Cosman F, Nieves J, Zion M, et al. Daily and cyclic parathyroid hormone in women receiving alendronate. N Engl J Med, 2005, 353: 566-575.
16. McClung MR, San Martin J, Miller PD, et al. Opposite bone remodeling effects of teriparatide and alendronate in increasing bone mass. Arch Intern Med, 2005, 165: 1762-1768.
17. Hodsman AB, Hanley DA, Ettinger MP, et al. Efficacy and safety of human parathyroid hormone-(1-84) in increasing bone mineral density in postmenopausal osteoporosis. J Clin Endocrinol Metab, 2003, 88: 5212-5220.
18. Black DM, Greenspan SL, Ensrud KE, et al. The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. N Engl J Med, 2003, 349: 1207-1215.
19. Body JJ, Gaich GA, Scheele WH, et al. A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1-34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab, 2002, 87: 4528-4535.
20. Cosman F, Nieves J, Woelfert L, et al. Parathyroid hormone added to established hormone therapy: effects on vertebral fracture and maintenance of bone mass after parathyroid hormone withdrawal. J Bone Miner Res, 2001, 16: 925-931.
21. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med, 2001, 344: 1434-1441.
22. Hodsman AB, Bauer DC, Dempster DW, et al. Parathyroid Hormone and Teriparatide for the Treatment of Osteoporosis: A Review of the Evidence and Suggested Guidelines for Its Use. Endocrine Reviews, 2005, 26(5): 688-703.
23. Vahle JL, Sato M, Long GG, et al. Skeletal changes in rats given daily subcutaneous injections of recombinant human parathyroid hormone(1-34) for 2 years and relevance to human safety. Toxicol Pathol, 2002, 30: 312-321.

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Parathyroid Hormone for the Prevention and Treatment of Postmenopausal Osteoporosis: A Systematic Review

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