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Clinical Information
Regulatory
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PTH(1-34) (subcutaneous)
- Clinical Information
- ACP Journal Club
- ACP Medicine
| ACP Medicine (as of 8/2005): |
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From: VI Diseases of Calcium Metabolism and Metabolic Bone Disease (external link)
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Authors: Holt EH et al. |
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"To date, teriparatide is the anabolic agent with the most potent effects on BMD. Its effects are particularly dramatic in the spine: in one study comparing teriparatide and alendronate treatment, at the end of 14 months, alendronate-treated patients had a 5.6% increase in lumbar spine BMD, whereas teriparatide-treated patients had a 12.2% increase. It should be noted, however, that teriparatide has not been demonstrated to prevent hip fracture, and it does not have FDA approval for that purpose."
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- Clinical Evidence
| Clinical Evidence (as of 1/2006): |
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From: Fracture prevention in postmenopausal women (external link)
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Authors: Mosekilde L et al |
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"Alendronate, risedronate and parathyroid hormone reduce vertebral and non-vertebral fractures compared with placebo."
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- MKSAP
| MKSAP 14 (as of 12/2006): |
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From: Therapy for Postmenopausal Osteoporosis (external link)
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"Teriparatide (recombinant human PTH [1-34]) is the only anabolic agent, whereas all the other medications are antiresorptive. When given intermittently, teriparatide stimulates osteoblastic bone formation. It is given as a subcutaneous injection and should not be used for more than 2 years. Teriparatide significantly increases bone mass and can decrease the incidence of both vertebral and nonvertebral fractures. Animal studies have shown an increased risk of osteosarcoma; therefore, this agent should be avoided in patients with Paget's disease of bone, previous radiation involving the skeleton, and a history of skeletal cancer. Because of its expense it should not be used as a first-line agent. Teriparatide should be considered in patients who are intolerant of other medications and in those with the greatest fracture risk."
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- PIER
| PIER (as of 11/28/2006): |
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From: Osteoporosis: Drug Therapy (external link)
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Authors: Inzucchi S |
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"• Consider teriparatide at a dose of 20 µg, injected subcutaneously, once daily for 18 to 24 months for patients at high risk for fracture."
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- UpToDate
| UpToDate (as of 8/2006): |
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From: Parathyroid hormone therapy for osteoporosis (external link)
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Authors: Rosen CJ |
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"• In men and women with severe osteoporosis (low bone mineral density [T score <-2.5] and at least one fragility fracture) who continue to fracture after one year of bisphosphonate therapy, we suggest human recombinant PTH therapy (Grade 2B).
• We also suggest PTH therapy for patients with severe osteoporosis who are unable to tolerate any of the available bisphosphonates (Grade 2B).
• Previous or current bisphosphonate use "blunts" the response to PTH. We suggest starting PTH approximately three months after bisphosphonates are discontinued (Grade 2C). It is reasonable to start PTH sooner in patients who were only briefly on bisphosphonates.
• We suggest stopping PTH treatment after a maximum of 24 months, because of concerns about osteosarcomas which have been observed in rats receiving high doses of PTH (Grade 2C). This complication has not been observed in human subjects.
• For patients at high risk for subsequent fracture after discontinuing PTH, we suggest starting a bisphosphonate after PTH is discontinued (Grade 2B)."
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- Patient Information
- MedlinePlus (external link)
- UpToDate
| UpToDate (as of 2006): |
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From: Patient information: Osteoporosis prevention and treatment (external link)
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Authors: Rosen HN |
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"Parathyroid hormone (PTH) - Produced by the parathyroid glands, PTH, stimulates both resorption and new bone formation. Intermittent administration stimulates formation more than resorption. Clinical trials to date suggest that PTH therapy is effective in both the prevention and treatment of osteoporosis, and a preparation called Forteo, given by daily injection, is now FDA approved for the treatment of severe osteoporosis. Forteo is more effective at building spine bone density than any other treatment. However, because it requires daily injection, and because of its expense, it is usually reserved for patients with very severe spine osteoporosis."
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- Regulatory
PTH(1-34) (nasal)
PTH-related peptide (nasal)
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