Department of Orthopaedics, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.
Int J Clin Pract. 2012 Feb;66(2):199-209. doi: 10.1111/j.1742-1241.2011.02837.x.
To determine the efficacy of teriparatide supplementation for improving bone mineral density (BMD) and fracture risk in postmenopausal osteoporosis and if effects vary with factors. We identified eight randomised controlled trials (n = 2388) using electronic databases, supplemented by a hand-search of the reference lists. All trials aimed to evaluate the efficacy of daily subcutaneous teriparatide injection in postmenopausal osteoporosis. The main outcomes were fracture risk and percentage change of BMD from baseline. Data were pooled by employing a random-effect model. In trials that reported BMD as an outcome, treatment was associated with an increase of bone mass of 8.14% [95% confidence interval (CI): 6.72-9.55%; eight trials, n = 2206] in spine and 2.48% (95% CI: 1.67-3.29%; seven trials, n = 1303) at the hip. In trials that reported fracture as an outcome, treatment was associated with a 70% risk reduction in vertebral fractures (risk ratio 0.30, 95% CI: 0.21-0.44; three trials, n = 1452) and 38% risk reduction in non-vertebral fractures (risk ratio 0.62, 95% CI: 0.44-0.87; three trials, n = 1842). The PTH treatment with total calcium intake more than 1500 mg was related to a significant increase in BMD gains at total hip (1.40% vs. 3.72%; p = 0.004). However, long-term duration did not appear to contribute to differences in responsiveness to teriparatide. Evidence supports the use of teriparatide in treatment of women with postmenopausal osteoporosis who are at risk for fracture. Further studies directly comparing concurrent therapy and calcium supplement with long-term duration are warranted.
为了确定甲状旁腺素（teriparatide）补充治疗在绝经后骨质疏松症中的疗效，以及这种疗效是否因各种因素而有所不同，我们检索了电子数据库，同时辅以手工检索参考文献，共确定了 8 项随机对照试验（n = 2388）。这些试验均旨在评估每日皮下注射 teriparatide 治疗绝经后骨质疏松症的疗效。主要结局为骨折风险和基线时骨密度（BMD）的百分比变化。我们采用随机效应模型进行数据分析。在报告 BMD 为结局的试验中，治疗与骨量增加 8.14%相关（95%置信区间[CI]：6.72%-9.55%；8 项试验，n = 2206），脊柱骨密度增加 2.48%（95%CI：1.67%-3.29%；7 项试验，n = 1303），髋部骨密度增加 2.48%。在报告骨折为结局的试验中，治疗与椎体骨折风险降低 70%相关（风险比[RR] 0.30，95%CI：0.21-0.44；3 项试验，n = 1452），非椎体骨折风险降低 38%相关（RR 0.62，95%CI：0.44-0.87；3 项试验，n = 1842）。甲状旁腺素治疗时总钙摄入量大于 1500 mg 与全髋关节 BMD 增加（1.40% vs. 3.72%；p = 0.004）显著相关。然而，长期治疗时间似乎不会影响对甲状旁腺素的反应。证据支持在骨折风险较高的绝经后骨质疏松症女性中使用甲状旁腺素治疗。有必要开展直接比较联合治疗和长期补钙治疗的临床试验。
