title: Single and combined use of human parathyroid hormone (PTH) (1-34) on areal bone mineral density (aBMD) in postmenopausal women with osteoporosis: evidence based on 9 RCTs.
abstract: BACKGROUND
  Human parathyroid hormone (PTH) (1-34) or teriparatide (TPTD) is an anabolic agent for osteoporosis. This recombinant protein stimulates positive bone formation balance and bone remodeling. However, when concomitantly used with antiresorptive (AR) agents, previous studies reported conflicting results in their potential additive and synergistic effects on bone metabolism and bone mineral density (BMD). This study aimed to integrate previous evidence to assess the effect of TPTD monotherapy and the additive effect of TPTD on AR agents in postmenopausal women with osteoporosis.
  
  
  METHODS
  This meta-analysis identified 9 RCTs from databases. To assess the therapeutic effect on osteoporosis, the weighted mean differences (WMDs) were used to pool the percentage change of BMD along with the 95% confidence intervals (CIs). BMD of 3 skeletal sites, including lumbar spine, total hip, and femoral neck were assessed.
  
  
  RESULTS
  TPTD alone could significantly improve BMD of all 3 skeletal sites compared with placebo, although the effect on the femoral neck was less conclusive. The additive effect of TPTD over hormone replacement therapy (HRT) and denosumab (DEN) agents is evident in all 3 skeletal sites. But TPTD plus Alendronate (ALN) did not demonstrate additive effect in total hip and femoral neck.
  
  
  CONCLUSIONS
  TPTD alone could significantly improve BMD of lumbar spine, total hip, and femoral neck. BMD outcomes of concomitant use of TPTD and AR agents are site-dependent and vary depending on the specific AR agent used and the timing of AR therapy initiation.
authors.affiliation: Department of Orthopedics, Shanxi People's Hospital, Taiyuan, Shanxi, China (mainland).
authors.forename: Jiefu
authors.initials: J
authors.lastname: Song
authors.affiliation: Department of Orthopedics, Shanxi People's Hospital, Taiyuan, Shanxi, China (mainland).
authors.forename: Zhizhen
authors.initials: Z
authors.lastname: Jin
authors.affiliation: Department of Orthopedics, Shanxi People's Hospital, Taiyuan, Shanxi, China (mainland).
authors.forename: Feng
authors.initials: F
authors.lastname: Chang
authors.affiliation: Department of Orthopedics, Shanxi People's Hospital, Taiyuan, Shanxi, China (mainland).
authors.forename: Lijun
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Orthopedics, Shanxi People's Hospital, Taiyuan, Shanxi, China (mainland).
authors.forename: Yunxing
authors.initials: Y
authors.lastname: Su
mesh_terms: D015519:Bone Density / Q000187:drug effects*; D004359:Drug Therapy, Combination; D005260:Female; D005272:Femur Neck / Q000187:drug effects / Q000503:physiopathology; D006615:Hip / Q000503:physiopathology; D006801:Humans; D008159:Lumbar Vertebrae / Q000187:drug effects / Q000503:physiopathology; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy* / Q000503:physiopathology*; D017594:Publication Bias; D016032:Randomized Controlled Trials as Topic; D019379:Teriparatide / Q000494:pharmacology / Q000627:therapeutic use*
chemical_list: D019379:Teriparatide