Parathyroid hormone for the treatment of osteoporosis: a systematic review.
BACKGROUND
Human parathyroid hormone (hPTH)(1-34) was approved in 2004 for the treatment of severe osteoporosis. Members of the Osteoporosis Canada clinical guidelines committee conducted a systematic review of randomized controlled trials (RCTs) to assess the efficacy and safety of hPTH for fracture prevention in postmenopausal women and men with osteoporosis.


METHODS
We searched MEDLINE, EMBASE, HTA, Current Contents and the Cochrane Controlled Trials Registry for published data from 1966 to February 2005. A systematic literature search for RCTs was conducted using the Cochrane Collaborative approach. We identified 12 trials that randomly assigned patients either to hPTH or placebo or to hPTH or an active comparator and were at least 1 year in duration. Outcomes included change in bone mineral density (BMD), fractures, back pain and adverse events. Two independent reviewers abstracted data on study characteristics and outcomes.


RESULTS
hPTH(1-34) significantly increases lumbar spine BMD, with smaller increases at the femoral neck and total hip. hPTH(1-84) significantly increases lumbar spine BMD. The data show a significant reduction in both vertebral and nonvertebral fractures with hPTH(1-34) in postmenopausal women with previous vertebral fractures. There were no data on fractures comparing the approved dose of hPTH(1-34) with active comparators.


CONCLUSIONS
There is Level I evidence that hPTH(1-34) significantly increases BMD at all skeletal sites except the radius and significantly reduces the risk of new vertebral and nonvertebral fractures in postmenopausal women with prior fractures.
Cranney
Ann
A
Department of Medicine, University of Ottawa, Ottawa, Ont.
Papaioannou
Alexandra
A
Zytaruk
Nicole
N
Hanley
David
D
Adachi
Jonathan
J
Goltzman
David
D
Murray
Timothy
T
Hodsman
Anthony
A
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000368:Aged; D001416:Back Pain / Q000209:etiology / Q000517:prevention & control; D015519:Bone Density / Q000187:drug effects; D004164:Diphosphonates / Q000627:therapeutic use; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy* / Q000209:etiology; D010281:Parathyroid Hormone / Q000009:adverse effects / Q000627:therapeutic use*; D017698:Postmenopause; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D004164:Diphosphonates; D010281:Parathyroid Hormone