Teriparatide (recombinant human parathyroid hormone 1-34) in postmenopausal women with osteoporosis: systematic review

Abstract

CONTEXT AND OBJECTIVE: Osteoporosis is defined as a disease characterized by low bone mass and deterioration of the bone tissue microarchitecture. Teriparatide stimulates the formation and action of osteoblasts, which are responsible for bone formation, thus promoting bone tissue increase. The aim was to assess the effectiveness and safety of teriparatide for treating postmenopausal osteoporosis. METHODS: A systematic review was conducted using the Cochrane Collaboration methodology. RESULTS: 1) Teriparatide 20 µg or 40 µg versus placebo: there was a benefit from teriparatide, considering the following outcomes: reduction in the number of new vertebral and non-vertebral fractures, and increased whole-body, lumbar and femoral bone mineral density. 2) Teriparatide 40 µg versus alendronate 10 mg/day for 14 months: there was no statistical difference regarding the incidence of new vertebral or non-vertebral fractures, although in the group that received teriparatide there was greater bone mineral density increase in the whole body, lumbar column and femur. 3) Estrogen plus teriparatide 25 µg versus estrogen: there was a benefit, considering the following outcomes: reduction in the number of new vertebral fractures, and increased whole-body, lumbar and femoral bone mineral density after three years. CONCLUSIONS: When teriparatide is intermittently administered in low doses, it reduces the incidence of vertebral fractures (67%) and non-vertebral fractures (38%) and increases bone mineral density in the lumbar column and femur. There is a need for studies with longer observation in order to allow conclusions regarding the safety and duration of the therapeutic effects.

Comparative effects of teriparatide and ibandronate on spine bone mineral density (BMD) and microarchitecture (TBS) in postmenopausal women with osteoporosis: a 2-year open-label study

“…These results are consistent with the results of several prior studies demonstrating some benefit of parathyroid hormones in the aftermath of bisphosphonate therapy [41,44,47] although it is the first time that results are reported with TBS.…”

“…8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 Teriparatide exerts primarily bone anabolic effects, which include increasing cancellous bone volume and connectivity, increasing cortical bone thickness, and enhancing trabecular morphology [39,40]. Since the inaugural publication by Neer et al in 2001 [27], several smaller studies have confirmed that teriparatide allows for strong BMD increases and for fracture risk reduction, suggesting that it may become an attractive alternative to bisphosphonates for strengthening and possibly restoring bone microarchitecture [41][42][43][44]. In the present study, a 2-year therapy with subcutaneous teriparatide induced a statistically significant increase in LS BMD and TBS of large magnitude.…”

Methodological quality of systematic reviews and clinical trials on women's health published in a Brazilian evidence-based health journal

“…All SRs were on gynecological topics: teriparatide for osteoporosis in post-menopausal women (10), lapatinib for advanced or metastasized breast cancer (11), comparative evaluation of digital mammography and film mammography (12), colposcopic triage methods for grade 3 cervical intraepithelial neoplasia (CIN3) after a cytopathological diagnosis of a low-grade squamous intraepithelial lesion (13) and risk of persistent high-grade squamous intraepithelial lesion after an electrosurgical excision with positive margins (14). Three of the reviews focused on treatment (10,11,14), and two focused on diagnosis (12,13). Three of these SRs presented meta-analyses of their results (10,13,14).…”

Monitoring of Cellular Changes in the Bone Marrow following PTH(1-34) Treatment of OVX Rats Using a Portable Stray-Field NMR Scanner

“…PTH(1-34), a recombinant human parathyroid hormone analogue containing the 34 residues, is currently used as an anabolic drug to treat osteoporosis in animals and humans [8] and to increase bone mass [9]. Importantly, PTH treatment is ineffective in many cases and chronic treatment over long periods (years) may have a catabolic effect [2].…”