PARATHYROID HORMONE AND TERIPARATIDE FOR THE TREATMENT OF OSTEOPOROSIS: A REVIEW OF THE EVIDENCE AND SUGGESTED GUIDELINES FOR ITS USE. Corresponding Author

All therapies currently recommended for the management of osteoporosis act mainly to inhibit bone resorption and reduce bone remodeling. Parathyroid hormone and its analog, teriparatide (recombinant human PTH(1-34), represent a new class of anabolic therapies for the treatment of severe osteoporosis, having the potential to improve skeletal micro-architecture. Significant reductions in both vertebral and appendicular fracture rates have been demonstrated in the phase 3 trial of teriparatide, involving elderly women with at least 1 prevalent vertebral fracture prior to the onset of therapy. However there is as yet no evidence that the anti-fracture efficacy of PTH will be superior to the bisphosphonates, 100 whilst cost-utility estimates suggest that teriparatide is significantly more expensive. Teriparatide should be considered as treatment for post-menopausal women and men with severe osteoporosis, as well as for patients with established glucocorticoid-induced osteoporosis who require long-term steroid treatment. Teriparatide should also be considered for the management of individuals at particularly high risk for fractures, including subjects who are younger than age 65 and who have particularly low BMD measurements (T-scores ≤3.5). Teriparatide therapy is not recommended beyond 2 years, in part based on the induction of osteosarcoma in a rat model of carcinogenicity. 110 Total daily calcium intake from both supplements and dietary sources should be limited to 1500 mg together with adequate vitamin D intake (up to 1000 units/day). Monitoring of serum calcium may be safely limited to measurement after one month of treatment; mild hypercalcemia may be treated by either withdrawing dietary calcium supplements, 4 reducing the dosing frequency of PTH, or both. At present, concurrent therapy with anti-resorptive therapy, particularly bisphosphonates should be avoided, although sequential therapy with such agents may consolidate the beneficial effects upon the skeleton after PTH is discontinued. Glossary: PTH – Refers to all general information with respect to the actions of Parathyroid Hormone.