PTH analogues and osteoporotic fractures

Importance of the field: At present there are two parathyroid hormone (PTH) analogues (PTH 1-34 and PTH 1-84) registered for the treatment of established osteoporosis in postmenopausal women (PTH 1-34 and PTH 1-84) and in men (PTH 1-34 only) who are at increased risk of having a fracture. Areas covered in this review: The efficacy and safety of PTH 1-34 and PTH 1-84 in the management of osteoporosis is evaluated by reviewing published literature and presentations from scientific meetings through to 2010. What the reader will gain: This review focuses on data on fracture risk reduction and safety endpoints of PTH analogues. The adverse reactions reported most are nausea, pain in the extremities, headache and dizziness. Take home message: Exogenous PTH analogues, given as daily subcutaneous injections, stimulate bone formation, increase bone mass and bone strength, and improve calcium balance. In postmenopausal women with osteoporosis, PTH analogues reduced the risk of vertebral (PTH 1-34 and PTH 1-84) and non-vertebral fractures (only PTH 1-34). In men and women with glucocorticosteroid-induced osteoporosis, PTH 1-34 reduced the risk of vertebral fractures. In general, PTH analogues are well tolerated with an acceptable safety profile: they can be used for the prevention and treatment of fractures in postmenopausal women with severe, established osteoporosis.