Parathyroid Hormone (1-34) For The Treatment Of Postmenopausal Osteoporosis: A Systematic Review

Objective:To systematically review the efficacy and safety of amino- terminal peptide 1–34 of parathyroid hormone (PTH (1–34)) on bone mineral density(BMD)and fractures in postmenopausal women with osteoporosis.Methods:To search MEDLINE (1966 to 2008.7), EMBASE(1974 to 2008.7), The Cochrane library (Issue 2,2008), Current Controlled Trials, The National Research Register, CBM(1983 to 2008.7), CNKI(1994 to 2008.7) electronically. Some related journals were handsearched as well. The search was concluded in July, 2008. The quality of included randomized controlled trials (RCTs) was evaluated and meta-analysis was conducted by RevMan 5.0.Results:8 studies including 2513 patients were identified. PTH(1-34) alone or in combination with antiresorptive drugs increased spine and total hip BMD, reduced vertebral(RR=0.32, 95%CI : 0.23-0.45 , P < 0.00001) and non-vertebral (RR=0.57,95% CI:0.39–0.85,P=0.005) fracture risk significantly during 12-36 months. Patients dropping out and lossing to follow-up because of adverse events were significantly more in PTH group [Peto-OR=1.56,95%CI:1.15-2.12,P=0.004].Conclusion:PTH(1-34)is effective in treatment of postmenopausal osteoporosis, especially in patients with preexisting osteoporotic fractures or with very low bone density. PTH(1-34) alone or in combination with antiresorptive drugs can increase spine and total hip BMD, reduce the risk of vertebral and non-vertebral fractures.