Metcalf Louis M, Aspray Terry J, McCloskey Eugene V
MRC-Arthritis Research UK Centre for Integrated research into Musculoskeletal Ageing (CIMA), Department of Oncology and Metabolism, University of Sheffield, UK; Mellanby Centre for Bone Research, Department of Oncology and Metabolism, University of Sheffield, UK.
Institute for Cellular Medicine, Newcastle University, UK.
Bone. 2017 Jun;99:39-46. doi: 10.1016/j.bone.2017.03.007. Epub 2017 Mar 9.
Given current developments in anabolic therapy for bone, we wished to document the effects of the only currently available anabolic therapy, parathyroid hormone (PTH) peptides, on the peripheral skeleton of postmenopausal women. We undertook a systematic review of English articles using MEDLINE, Scopus and the Cochrane Controlled Trials Register (final update 28th March 2016). Additional studies were identified through searches of bibliographies. Studies included those comparing PTH peptides with placebo, with anti-osteoporotic treatments and in combination therapies. Participants had to be postmenopausal women and outcomes included areal or volumetric bone mineral density (BMD) and measurements of bone microarchitecture at peripheral sites, such as the forearm and tibia. Data were extracted independently and reviewed by EVM and LMM. Data on study design were also collected for methodological risk of bias assessment. The heterogeneity between studies, regarding the drug dose and duration, and the site measured, prevented grouped meta-analysis. There were no significant differences in areal BMD between PTH peptides and placebo at peripheral skeletal sites at 12months. A decrease in aBMD occurred with PTH(1-34) (larger dose) and PTH(1-84) treatment at 18months follow-up in comparison to the placebo arms. Anti-resorptives seemed to attenuate losses of aBMD at peripheral sites when compared to PTH peptides monotherapy, likely mediated by lower cortical porosity. Finally, PTH peptides combined with bisphosphonates or denosumab attenuated peripheral BMD losses in comparison to PTH peptide monotherapy, with evidence of increased BMD at ultradistal peripheral sites when PTH(1-34) was combined with denosumab or hormone replacement therapy. This summary should act as a reference point for the comparison of new anabolic therapies, specifically in comparison to PTH(1-34).
鉴于目前骨合成代谢疗法的发展情况，我们希望记录当前唯一可用的合成代谢疗法——甲状旁腺激素（PTH）肽对绝经后女性外周骨骼的影响。我们使用MEDLINE、Scopus和Cochrane对照试验注册库（2016年3月28日最终更新）对英文文章进行了系统综述。通过检索参考文献确定了其他研究。研究包括将PTH肽与安慰剂、抗骨质疏松治疗以及联合疗法进行比较的研究。参与者必须是绝经后女性，结局指标包括面积或体积骨密度（BMD）以及外周部位（如前臂和胫骨）骨微结构的测量。数据由EVM和LMM独立提取并审核。还收集了研究设计数据用于方法学偏倚风险评估。由于研究之间在药物剂量、持续时间和测量部位方面存在异质性，无法进行分组荟萃分析。在12个月时，PTH肽与安慰剂在外周骨骼部位的面积BMD没有显著差异。与安慰剂组相比，在18个月随访时，PTH（1 - 34）（较大剂量）和PTH（1 - 84）治疗导致面积BMD下降。与PTH肽单药治疗相比，抗吸收药物似乎减轻了外周部位面积BMD的损失，这可能是由较低的皮质孔隙率介导的。最后，与PTH肽单药治疗相比，PTH肽与双膦酸盐或地诺单抗联合使用可减轻外周BMD损失，当PTH（1 - 34）与地诺单抗或激素替代疗法联合使用时，有证据表明超远端外周部位的BMD增加。本综述应作为比较新的合成代谢疗法的参考点，特别是与PTH（1 - 34）进行比较时。
