Cosman Felicia
Columbia College of Physicians and Surgeons, Columbia University, New York, New York, USA.
Curr Opin Endocrinol Diabetes Obes. 2008 Dec;15(6):495-501. doi: 10.1097/MED.0b013e32831a46d6.
There has recently been a dramatic expansion of clinical investigation of parathyroid hormone (PTH). There are no other anabolic agents on the horizon at the current time but clearly there are a large number of questions that remain about this powerful agent for osteoporosis.
The present study reviews clinical trials using PTH alone and in combination and sequence with antiresorptive agents in postmenopausal women and briefly overviews trials in glucocorticoid-induced osteoporosis in men. PTH will be referred to as teriparatide when it is the recombinant human PTH(1-34) fragment produced by Lilly (Indianapolis, Indiana, USA) or the human PTH(1-34) produced by biochemical synthetic methods (Bachem, California, USA); and PTH(1-84) as the intact human recombinant molecule developed by NPS Pharmaceuticals (Salt Lake City, Utah, USA). PTH without other designation denotes either of the compounds.
Because PTH improves microarchitecture, macroarchitecture and mass of bone, it might produce better long-term protection against fracture, when given first and followed by antiresorptive therapy, compared with antiresorptive agents alone. Results of studies on combination therapy must distinguish previously untreated vs. previously treated individuals. PTH should be considered in women with persistent osteoporosis on established bisphosphonates or raloxifene, in which adding PTH might produce better results than switching to PTH. There are still many unanswered questions concerning PTH therapy, one of the most important being the optimal regimen.
近期甲状旁腺激素（PTH）的临床研究有了显著扩展。目前尚无其他促合成药物，但显然对于这种治疗骨质疏松的强效药物仍存在大量问题。
本研究回顾了绝经后女性单独使用PTH以及PTH与抗吸收药物联合和序贯使用的临床试验，并简要概述了男性糖皮质激素性骨质疏松的试验。当PTH为美国礼来公司（印第安纳波利斯，印第安纳州）生产的重组人PTH(1 - 34)片段或美国巴彻姆公司（加利福尼亚州）通过生化合成方法生产的人PTH(1 - 34)时，将其称为特立帕肽；而PTH(1 - 84)是美国NPS制药公司（盐湖城，犹他州）研发的完整重组人分子。未作其他指定的PTH表示上述两种化合物中的任何一种。
由于PTH可改善骨的微观结构、宏观结构和骨量，与单独使用抗吸收药物相比，先给予PTH然后进行抗吸收治疗可能会产生更好的长期骨折预防效果。联合治疗研究的结果必须区分既往未治疗与既往已治疗的个体。对于使用已确立的双膦酸盐或雷洛昔芬后仍持续存在骨质疏松的女性，应考虑使用PTH，在这种情况下，加用PTH可能比改用PTH产生更好的效果。关于PTH治疗仍有许多未解决的问题，其中最重要的一个是最佳治疗方案。
