Calcified Tissue International

, Volume 84, Issue 3, pp 159–170

Treatment of Osteoporosis with Parathyroid Hormone and Teriparatide

  • Johannes Pleiner-Duxneuner
  • Elisabeth Zwettler
  • Eleftherios Paschalis
  • Paul Roschger
  • Valerie Nell-Duxneuner
  • Klaus Klaushofer
Article

Abstract

Nowadays osteoporosis treatment is based primarily on therapy with antiresorptive agents, like the bisphosphonates. Parathyroid hormone (Preotact) and human recombinant parathyroid hormone peptide 1–34 (Teriparatide) are relatively new for the treatment of osteoporosis and belong to the group of anabolic agents. Both agents demonstrated an increase in bone mineral density and a significant reduction in vertebral fractures in postmenopausal women with osteoporosis when given for 18–24 months. Data on nonvertebral fractures are, however, not clear-cut, and so far only bisphosphonates and strontium ranelate have been demonstrated to reduce all types of fractures and therefore remain the front-line option for treatment of osteoporosis. As the safety, tolerability, and cost of the therapy also influence the choice of therapy, Preotact and Teriparatide might be useful additions to the armamentarium for (second-line) treatment of osteoporosis.

Keywords

Preotact Teriparatide Osteoporosis Anabolic Bone mineral density 

References

  1. 1.
    Ettinger MP (2003) Aging bone and osteoporosis: strategies for preventing fractures in the elderly. Arch Intern Med 163:2237–2246PubMedCrossRefGoogle Scholar
  2. 2.
    Rosen CJ (2005) Clinical practice. Postmenopausal osteoporosis. N Engl J Med 353:595–603PubMedCrossRefGoogle Scholar
  3. 3.
    Dempster DW, Parisien M, Silverberg SJ, Liang XG, Schnitzer M, Shen V, Shane E, Kimmel DB, Recker R, Lindsay R, Bilezikian JP (1999) On the mechanism of cancellous bone preservation in postmenopausal women with mild primary hyperparathyroidism. J Clin Endocrinol Metab 84:1562–1566PubMedCrossRefGoogle Scholar
  4. 4.
    Rubin MR, Bilezikian JP (2002) New anabolic therapies in osteoporosis. Curr Opin Rheumatol 14:433–440PubMedCrossRefGoogle Scholar
  5. 5.
    Roschger P, Dempster DW, Zhou H, Paschalis EP, Silverberg SJ, Shane E, Bilezikian JP, Klaushofer K (2007) New observations on bone quality in mild primary hyperparathyroidism as determined by quantitative backscattered electron imaging. J Bone Miner Res 22:717–723PubMedCrossRefGoogle Scholar
  6. 6.
    Misof BM, Roschger P, Cosman F, Kurland ES, Tesch W, Messmer P, Dempster DW, Nieves J, Shane E, Fratzl P, Klaushofer K, Bilezikian J, Lindsay R (2003) Effects of intermittent parathyroid hormone administration on bone mineralization density in iliac crest biopsies from patients with osteoporosis: a paired study before and after treatment. J Clin Endocrinol Metab 88:1150–1156PubMedCrossRefGoogle Scholar
  7. 7.
    Roschger P, Paschalis EP, Fratzl P, Klaushofer K (2008) Bone mineralization density distribution in health and disease. Bone 42:456–466PubMedCrossRefGoogle Scholar
  8. 8.
    Kneissel M, Boyde A, Gasser JA (2001) Bone tissue and its mineralization in aged estrogen-depleted rats after long-term intermittent treatment with parathyroid hormone (PTH) analog SDZ PTS 893 or human PTH(1–34). Bone 28:237–250PubMedCrossRefGoogle Scholar
  9. 9.
    Potts JT (2005) Parathyroid hormone: past and present. J Endocrinol 187:311–325PubMedCrossRefGoogle Scholar
  10. 10.
    Stroup J, Kane MP, Abu-Baker AM (2008) Teriparatide in the treatment of osteoporosis. Am J Health Syst Pharm 65:532–539PubMedCrossRefGoogle Scholar
  11. 11.
    Whitfield JF, Morley P (1995) Small bone-building fragments of parathyroid hormone: new therapeutic agents for osteoporosis. Trends Pharmacol Sci 16:382–386PubMedCrossRefGoogle Scholar
  12. 12.
    Schwietert HR, Groen EW, Sollie FA, Jonkman JH (1997) Single-dose subcutaneous administration of recombinant human parathyroid hormone [rhPTH(1–84)] in healthy postmenopausal volunteers. Clin Pharmacol Ther 61:360–376PubMedCrossRefGoogle Scholar
  13. 13.
    Lindsay R, Nieves J, Henneman E, Shen V, Cosman F (1993) Subcutaneous administration of the amino-terminal fragment of human parathyroid hormone-(1–34): kinetics and biochemical response in estrogenized osteoporotic patients. J Clin Endocrinol Metab 77:1535–1539PubMedCrossRefGoogle Scholar
  14. 14.
    Kimmel DB, Bozzato RP, Kronis KA, Coble T, Sindrey D, Kwong P, Recker RR (1993) The effect of recombinant human (1–84) or synthetic human (1–34) parathyroid hormone on the skeleton of adult osteopenic ovariectomized rats. Endocrinology 132:1577–1584PubMedCrossRefGoogle Scholar
  15. 15.
    Ejersted C, Andreassen TT, Oxlund H, Jorgensen PH, Bak B, Haggblad J, Torring O, Nilsson MH (1993) Human parathyroid hormone (1–34) and (1–84) increase the mechanical strength and thickness of cortical bone in rats. J Bone Miner Res 8:1097–1101PubMedCrossRefGoogle Scholar
  16. 16.
    Samnegard E, Iwaniec UT, Cullen DM, Kimmel DB, Recker RR (2001) Maintenance of cortical bone in human parathyroid hormone(1–84)-treated ovariectomized rats. Bone 28:251–260PubMedCrossRefGoogle Scholar
  17. 17.
    Dobnig H, Turner RT (1997) The effects of programmed administration of human parathyroid hormone fragment (1–34) on bone histomorphometry and serum chemistry in rats. Endocrinology 138:4607–4612PubMedCrossRefGoogle Scholar
  18. 18.
    Holick MF (2007) Vitamin D deficiency. N Engl J Med 357:266–281PubMedCrossRefGoogle Scholar
  19. 19.
    Hodsman AB, Hanley DA, Ettinger MP, Bolognese MA, Fox J, Metcalfe AJ, Lindsay R (2003) Efficacy and safety of human parathyroid hormone-(1–84) in increasing bone mineral density in postmenopausal osteoporosis. J Clin Endocrinol Metab 88:5212–5220PubMedCrossRefGoogle Scholar
  20. 20.
    Greenspan SL, Bone HG, Ettinger MP, Hanley DA, Lindsay R, Zanchetta JR, Blosch CM, Mathisen AL, Morris SA, Marriott TB (2007) Effect of recombinant human parathyroid hormone (1–84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis: a randomized trial. Ann Intern Med 146:326–339PubMedGoogle Scholar
  21. 21.
    Moen MD, Scott LJ (2006) Recombinant full-length parathyroid hormone (1–84). Drugs 66:2371–2381PubMedCrossRefGoogle Scholar
  22. 22.
    Greenspan SL, Hanley DA, Morris SA, Marriott TB (2006) Bone turnover markers and BMD remain elevated in postmenopausal osteoporotic women through a full 24 months of treatment with human parathyroid hormone 1–84 (PTH). J Bone Miner Res 21:114CrossRefGoogle Scholar
  23. 23.
    Black DM, Greenspan SL, Ensrud KE, Palermo L, McGowan JA, Lang TF, Garnero P, Bouxsein ML, Bilezikian JP, Rosen CJ (2003) The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. N Engl J Med 349:1207–1215PubMedCrossRefGoogle Scholar
  24. 24.
    Black DM, Bilezikian JP, Ensrud KE, Greenspan SL, Palermo L, Hue T, Lang TF, McGowan JA, Rosen CJ (2005) One year of alendronate after one year of parathyroid hormone (1–84) for osteoporosis. N Engl J Med 353:555–565PubMedCrossRefGoogle Scholar
  25. 25.
    Stroup JS, Rivers SM, Abu-Baker AM, Kane MP (2007) Two-year changes in bone mineral density and T scores in patients treated at a pharmacist-run Teriparatide clinic. Pharmacotherapy 27:779–788PubMedCrossRefGoogle Scholar
  26. 26.
    Chen P, Miller PD, Recker R, Resch H, Rana A, Pavo I, Sipos AA (2007) Increases in bone mineral density correlate with improvements in bone microarchitecture with teriparatide treatment in postmenopausal women with osteoporosis. J Bone Miner Res 22:1173–1180PubMedCrossRefGoogle Scholar
  27. 27.
    Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, Hodsman AB, Eriksen EF, Ish-Shalom S, Genant HK, Wang O, Mitlak BH (2001) Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 344:1434–1441PubMedCrossRefGoogle Scholar
  28. 28.
    Body JJ, Gaich GA, Scheele WH, Kulkarni PM, Miller PD, Peretz A, Dore RK, Correa-Rotter R, Papaioannou A, Cumming DC, Hodsman AB (2002) A randomized double-blind trial to compare the efficacy of Teriparatide [recombinant human parathyroid hormone (1–34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 87:4528–4535PubMedCrossRefGoogle Scholar
  29. 29.
    Lindsay R, Nieves J, Formica C, Henneman E, Woelfert L, Shen V, Dempster D, Cosman F (1997) Randomised controlled study of effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis. Lancet 350:550–555PubMedCrossRefGoogle Scholar
  30. 30.
    Ettinger B, San Martin J, Crans G, Pavo I (2004) Differential effects of Teriparatide on BMD after treatment with raloxifene or alendronate. J Bone Miner Res 19:745–751PubMedCrossRefGoogle Scholar
  31. 31.
    Boonen S, Marin F, Obermayer-Pietsch B, Simoes ME, Barker C, Glass EV, Hadji P, Lyritis G, Oertel H, Nickelsen T, McCloskey EV (2008) Effects of previous antiresorptive therapy on the bone mineral density response to two years of Teriparatide treatment in 30. postmenopausal women with osteoporosis. J Clin Endocrinol Metab 93:852–860PubMedCrossRefGoogle Scholar
  32. 32.
    Vahle JL, Long GG, Sandusky G, Westmore M, Ma YL, Sato M (2004) Bone neoplasms in F344 rats given Teriparatide [rhPTH(1–34)] are dependent on duration of treatment and dose. Toxicol Pathol 32:426–438PubMedCrossRefGoogle Scholar
  33. 33.
    Orwoll ES, Scheele WH, Paul S, Adami S, Syversen U, Diez-Perez A, Kaufman JM, Clancy AD, Gaich GA (2003) The effect of Teriparatide [human parathyroid hormone (1–34)] therapy on bone density in men with osteoporosis. J Bone Miner Res 18:9–17PubMedCrossRefGoogle Scholar
  34. 34.
    Kaufman JM, Orwoll E, Goemaere S, San Martin J, Hossain A, Dalsky GP, Lindsay R, Mitlak BH (2005) Teriparatide effects on vertebral fractures and bone mineral density in men with osteoporosis: treatment and discontinuation of therapy. Osteoporos Int 16:510–516PubMedCrossRefGoogle Scholar
  35. 35.
    Finkelstein JS, Hayes A, Hunzelman JL, Wyland JJ, Lee H, Neer RM (2003) The effects of parathyroid hormone, alendronate, or both in men with osteoporosis. N Engl J Med 349:1216–1226PubMedCrossRefGoogle Scholar
  36. 36.
    Saag KG, Shane E, Boonen S, Marin F, Donley DW, Taylor KA, Dalsky GP, Marcus R (2007) Teriparatide or alendronate in glucocorticoid-induced osteoporosis. N Engl J Med 357:2028–2039PubMedCrossRefGoogle Scholar
  37. 37.
    Gold DT, Pantos BS, Masica DN, Misurski DA, Marcus R (2006) Initial experience with Teriparatide in the United States. Curr Med Res Opin 22:703–708PubMedCrossRefGoogle Scholar
  38. 38.
    Liberman UA, Weiss SR, Broll J, Minne HW, Quan H, Bell NH, Rodriguez-Portales J, Downs RW Jr, Dequeker J, Favus M (1995) Effect of oral alendronate on bone mineral density and the incidence of fractures in postmenopausal osteoporosis. The Alendronate Phase III Osteoporosis Treatment Study Group. N Engl J Med 333:1437–1443PubMedCrossRefGoogle Scholar
  39. 39.
    McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, Adami S, Fogelman I, Diamond T, Eastell R, Meunier PJ, Reginster JY (2001) Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 344:333–340PubMedCrossRefGoogle Scholar
  40. 40.
    Reginster JY, Felsenberg D, Boonen S, Diez-Perez A, Rizzoli R, Brandi ML, Spector TD, Brixen K, Goemaere S, Cormier C, Balogh A, Delmas PD, Meunier PJ (2008) Effects of long-term strontium ranelate treatment on the risk of nonvertebral and vertebral fractures in postmenopausal osteoporosis: results of a five-year, randomized, placebo-controlled trial. Arth Rheum 58:1687–1695CrossRefGoogle Scholar
  41. 41.
    Reginster JY, Seeman E, De Vernejoul MC, Adami S, Compston J, Phenekos C, Devogelaer JP, Curiel MD, Sawicki A, Goemaere S, Sorensen OH, Felsenberg D, Meunier PJ (2005) Strontium ranelate reduces the risk of nonvertebral fractures in postmenopausal women with osteoporosis: treatment of peripheral osteoporosis (TROPOS) study. J Clin Endocrinol Metab 9:2816–2822CrossRefGoogle Scholar
  42. 42.
    Canalis E, Giustina A, Bilezikian JP (2007) Mechanisms of anabolic therapies for osteoporosis. N Engl J Med 357:95–96CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Johannes Pleiner-Duxneuner
    • 1
    • 2
  • Elisabeth Zwettler
    • 1
  • Eleftherios Paschalis
    • 1
  • Paul Roschger
    • 1
  • Valerie Nell-Duxneuner
    • 1
  • Klaus Klaushofer
    • 1
  1. 1.4th Medicine Department, Hanusch HospitalLudwig Boltzmann Institute of Osteology at the Hanusch Hospital of WGKK and AUVA Trauma Centre MeidlingViennaAustria
  2. 2.Department of Clinical PharmacologyMedical University ViennaViennaAustria

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