title: Recombinant hormones in osteoporosis.
abstract: BACKGROUND
  For the last 10 years, bone anabolic therapy with the recombinant human parathyroid hormone (rhPTH) analogue, teriparatide (rhPTH[1 - 34]), or full-length rhPTH(1 - 84) has been an option in the treatment of osteoporosis. Both drugs are given as a daily subcutaneous injection. In the USA, only teriparatide is marketed.
  
  
  METHODS
  Mechanisms of action by which rhPTH induces bone anabolic effects includes changes in bone remodeling, geometry and mineral density. Data from randomized controlled trials on anti-fracture efficacy are reviewed as well as results from a number of recent studies on administration less than once-a-day or intermittent-/cyclic-therapy. Treatment effects are compared with those of anti-resorptive agents.
  
  
  CONCLUSIONS
  In terms of anti-fracture efficacy, treatment with rhPTH is not superior to treatment with potent anti-resorptive agents. However, while the process by which osteoporosis emerges is arrested in response to anti-resorptives, rhPTH acts as a bone anabolic with reversal of the process. Although this mechanism of action seems favorable, the use of rhPTH is limited by a much higher cost than that of anti-resorptive agents. As long as a superior anti-fracture efficacy has not been proven, rhPTH should be confined to patients with severe spinal osteoporosis, including patients in whom treatment with an anti-resorptive has failed.
authors: Aarhus University, Aarhus University Hospital, Department of Endocrinology and Internal Medicine, Tage-Hansens Gade 2, DK-8000 Aarhus C, Denmark. rejnmark@post6.tele.dk
authors: Lars
authors: L
authors: Rejnmark
mesh_terms: D000818:Animals; D006728:Hormones / Q000627:therapeutic use*; D006801:Humans; D010024:Osteoporosis / Q000628:therapy*; D011994:Recombinant Proteins / Q000627:therapeutic use*
chemical_list: D006728:Hormones; D011994:Recombinant Proteins