Teriparatide for the Prevention of Fractures in Postmenopausal Women

A systematic review 1 included 12 RCTs of at least 1-year duration that compared human parathyroid hormone (hPTH) with a placebo or with an active comparator. 9 studies involved postmenopausal women with osteoporosis, of which 1 involved postmenopausal women with corticosteroid-induced osteoporosis, and 3 studies involved men with osteoporosis. The primary outcome was the effect of hPTH(1-34) or hPTH(1-84) on either bone mineral density (BMD) or fractures. hPTH(1-34) significantly increased lumbar spine BMD, with smaller increases at the femoral neck and total hip. hPTH(1-84) significantly increased lumbar spine BMD.

hPTH(1-34) reduced both vertebral and nonvertebral fractures in postmenopausal women with previous vertebral fractures. In a large study 2 comparing hPTH(1-34) with calcium and vitamin D among women with severe osteoporosis and priorfractures, hPTH(1-34) 20 µg and 40 µg reduced new vertebral fractures (RR 0.35, 95% CI 0.22 to 0.55 and RR 0.31, 95% CI 0.19 to 0.50, respectively). Treatment with 20 µg hPTH(1-34) resultedin a RR of 0.47 (95% CI 0.25 to 0.88) for nonvertebral fractures. In other hPTH(1-34) studies, the absolutenumber of fractures was too small to achieve significance.

References

• Cranney A, Papaioannou A, Zytaruk N et al. Parathyroid hormone for the treatment of osteoporosis: a systematic review. CMAJ 2006;175(1):52-9. [PubMed]
• 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(19):1434-41. [PubMed]