Deal Chad
Center for Osteoporosis and Metabolic Bone Disease, Department of Rheumatology, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Curr Rheumatol Rep. 2004 Feb;6(1):49-58. doi: 10.1007/s11926-004-0083-3.
Parathyroid hormone (PTH), given intermittently, is an anabolic agent. PTH has been demonstrated to increase bone mass and reduce vertebral and nonvertebral fractures, and has been approved for use in the US and Europe. PTH is a genetically engineered 34 amino acid protein with the designation teriparatide (recombinant DNA origin) or recombinant human PTH 1-34. A recombinant DNA preparation with all 84 amino acids of the native PTH molecule is in clinical trials. These PTH preparations are self-administered daily injections, and it is approved for women and men at high risk for fractures, including patients with prevalent fractures, low bone mass, and multiple risk factors. PTH is likely to be used most frequently in patients who fracture on therapy, but can be used in high-risk treatment-naïve patients. Previous treatment with alendronate appears to impair the anabolic response of PTH preparations. Patients who have Paget's disease, prior radiation therapy to the skeleton, as well as children and young adults with open epiphyses, are at higher risk for osteosarcoma and should not be given PTH. Patients with hypercalcemia and hyperparathyroidism also should not receive the drug.
间歇性给予的甲状旁腺激素（PTH）是一种促合成代谢药物。已证实PTH可增加骨量并减少椎体和非椎体骨折，且已在美国和欧洲获批使用。PTH是一种经基因工程改造的含34个氨基酸的蛋白质，商品名为特立帕肽（源自重组DNA）或重组人PTH 1-34。一种含有天然PTH分子全部84个氨基酸的重组DNA制剂正在进行临床试验。这些PTH制剂需每日自行注射，已获批用于有高骨折风险的女性和男性，包括有既往骨折史、低骨量及多种风险因素的患者。PTH可能最常用于在治疗期间发生骨折的患者，但也可用于未接受过治疗的高风险患者。先前使用阿仑膦酸盐治疗似乎会削弱PTH制剂的促合成代谢反应。患有佩吉特病、既往接受过骨骼放疗的患者，以及骨骺未闭合的儿童和青少年，患骨肉瘤的风险较高，不应给予PTH治疗。高钙血症和甲状旁腺功能亢进患者也不应使用该药物。
