Randomised controlled study of effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis
Small increases in bone mass are commonly seen with existing treatments for osteoporosis, which reduce bone remodelling and primarily prevent bone loss. Since these drugs reduce but do not eliminate risk of fractures, an anabolic agent that would increase bone mass and potentially cure the underlyin...
Gespeichert in:
| Veröffentlicht in: | The Lancet (British edition) 1997-08, Vol.350 (9077), p.550-555 |
|---|---|
| Hauptverfasser: | , , , , , , , |
| Format: | Artikel |
| Sprache: | eng |
| Schlagworte: | |
| Online-Zugang: | Volltext |
| Tags: |
Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
|
| container_end_page | 555 |
|---|---|
| container_issue | 9077 |
| container_start_page | 550 |
| container_title | The Lancet (British edition) |
| container_volume | 350 |
| creator | Lindsay, Robert Nieves, Jeri Formica, Carmelo Henneman, Emily Woelfert, Lillian Shen, Victor Dempster, David Cosman, Felicia |
| description | Small increases in bone mass are commonly seen with existing treatments for osteoporosis, which reduce bone remodelling and primarily prevent bone loss. Since these drugs reduce but do not eliminate risk of fractures, an anabolic agent that would increase bone mass and potentially cure the underlying skeletal problem is needed.
We did a 3-year randomised controlled trial to find out the effects of 1–34 human parathyroid hormone (hPTH [1–34], 400 U/25 μg daily subcutaneously) in postmenopausal women with osteoporosis taking hormone-replacement therapy (n=17). The controls were women taking hormone-replacement therapy only (n=17). The primary outcome was bone-mineral density of the lumbar vertebrae, with bone-mineral density at other sites and vertebral fractures as secondary endpoints.
Patients taking hormone-replacement therapy and PTH (1–34) had continuous increase in vertebral bone-mineral density during the 3 years, whereas there was no significant change in the control group. The total increase in vertebral bone-mineral density was 13·0% (p |
| doi_str_mv | 10.1016/S0140-6736(97)02342-8 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_79267260</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>S0140673697023428</els_id><sourcerecordid>13932262</sourcerecordid><originalsourceid>FETCH-LOGICAL-c463t-173676ae7fae64b69ccb94008950bda5f5111efab739253660274b6db2ddd3ef3</originalsourceid><addsrcrecordid>eNqFkU2LFDEQhoMo67j6ExaCiOihNUmnk-mTyOIXLAh-gLeQTio7Wbo7bdK9y_wff6jVO8McvHhKJfXUm6p6Cbng7A1nXL39zrhkldK1etXq10zUUlTbB2TDpZZVI_Wvh2RzQh6TJ6XcMMakYs0ZOWvFVmqtN-TPNzv6NMQCnro0zjn1PYZlXvyepkAhBHDzGk0223m3zyl6ukt5SCPQNNJbyDN02fZVt74MthSKkjRk6-YlA42jix5GB9RizTWdUpkHGNNkl2J7epfwsgolKPj7NV7u4ryjSEGaUk4llqfkUbB9gWfH85z8_Pjhx-Xn6urrpy-X768qJ1U9VxwH1cqCDhaU7FTrXNdKxrZtwzpvm9BwziHYTtetaGqlmNCI-U5472sI9Tl5edCdcvq9YD8GF-Og7-0IaSlGt0JpoRiCz_8Bb9KSR-zN8LZlddNsOULNAXI4RMkQzJTjYPPecGZWC829hWb1x7Ta3Ftotlh3cRRfugH8qeroGeZfHPO2ONvjonHD5YQJZLhQiL07YIAbu42QTXFx9cHHjJYan-J_GvkLMjy8sg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>199035581</pqid></control><display><type>article</type><title>Randomised controlled study of effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals Complete</source><source>EBSCOhost Business Source Complete</source><source>ProQuest Central UK/Ireland</source><creator>Lindsay, Robert ; Nieves, Jeri ; Formica, Carmelo ; Henneman, Emily ; Woelfert, Lillian ; Shen, Victor ; Dempster, David ; Cosman, Felicia</creator><creatorcontrib>Lindsay, Robert ; Nieves, Jeri ; Formica, Carmelo ; Henneman, Emily ; Woelfert, Lillian ; Shen, Victor ; Dempster, David ; Cosman, Felicia</creatorcontrib><description>Small increases in bone mass are commonly seen with existing treatments for osteoporosis, which reduce bone remodelling and primarily prevent bone loss. Since these drugs reduce but do not eliminate risk of fractures, an anabolic agent that would increase bone mass and potentially cure the underlying skeletal problem is needed.
We did a 3-year randomised controlled trial to find out the effects of 1–34 human parathyroid hormone (hPTH [1–34], 400 U/25 μg daily subcutaneously) in postmenopausal women with osteoporosis taking hormone-replacement therapy (n=17). The controls were women taking hormone-replacement therapy only (n=17). The primary outcome was bone-mineral density of the lumbar vertebrae, with bone-mineral density at other sites and vertebral fractures as secondary endpoints.
Patients taking hormone-replacement therapy and PTH (1–34) had continuous increase in vertebral bone-mineral density during the 3 years, whereas there was no significant change in the control group. The total increase in vertebral bone-mineral density was 13·0% (p<0·001); 2·7% at the hip (p=0·05); and 8·0% in total-body bone mineral (p=0·002). No loss of bone mass was found at any skeletal site. Increased bone mass was associated with a reduction in the rate of vertebral fractures, which was significant when fractures were taken as a 15% reduction in vertebral height (p=0·04). During the first 6 months of treatment, serum osteocalcin concentration, which reflects bone formation, increased by more than 55%, whereas excretion of crosslinked n-telopeptide, which reflects bone resorption, increased by only 20%, which suggests some uncoupling of bone formation and resorption. By 6 months, there were similar increases in both markers, which gradually returned towards baseline as the study progressed. Vertebral bone-mineral density increased most during the first year of PTH treatment.
We found that PTH has a pronouned anabolic effect on the central skeleton in patients on hormone-replacement therapy. PTH also increases total-body bone mineral, with no detrimental effects at any skeletal site. The increased vertebral mass was associated with a reduced rate of vertebral fracture, despite increased bone turnover. Bone-mass changes may be consistent with a reduction in all osteoporotic fractures. If confirmed in larger studies, these data have important implications for the treatment of postmenopausal osteoporosis.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/S0140-6736(97)02342-8</identifier><identifier>PMID: 9284777</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Absorptiometry, Photon ; Aged ; Biological and medical sciences ; Biomarkers - analysis ; Bone Density - drug effects ; Bones ; Drug therapy ; Estrogen Replacement Therapy ; Estrogens - therapeutic use ; Female ; Fractures, Bone - epidemiology ; Fractures, Bone - prevention & control ; Hormones ; Hormones. Endocrine system ; Humans ; Incidence ; Medical sciences ; Menopause ; Middle Aged ; Osteoporosis ; Osteoporosis, Postmenopausal - drug therapy ; Osteoporosis, Postmenopausal - physiopathology ; Pharmacology. Drug treatments ; Postmenopause ; Spine ; Teriparatide - pharmacology ; Teriparatide - therapeutic use ; Women</subject><ispartof>The Lancet (British edition), 1997-08, Vol.350 (9077), p.550-555</ispartof><rights>1997 Elsevier Ltd</rights><rights>1997 INIST-CNRS</rights><rights>Copyright Lancet Ltd. Aug 23, 1997</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c463t-173676ae7fae64b69ccb94008950bda5f5111efab739253660274b6db2ddd3ef3</citedby><cites>FETCH-LOGICAL-c463t-173676ae7fae64b69ccb94008950bda5f5111efab739253660274b6db2ddd3ef3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/199035581?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,780,784,3550,27924,27925,45995,64385,64387,64389,72469</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2777126$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/9284777$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Lindsay, Robert</creatorcontrib><creatorcontrib>Nieves, Jeri</creatorcontrib><creatorcontrib>Formica, Carmelo</creatorcontrib><creatorcontrib>Henneman, Emily</creatorcontrib><creatorcontrib>Woelfert, Lillian</creatorcontrib><creatorcontrib>Shen, Victor</creatorcontrib><creatorcontrib>Dempster, David</creatorcontrib><creatorcontrib>Cosman, Felicia</creatorcontrib><title>Randomised controlled study of effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Small increases in bone mass are commonly seen with existing treatments for osteoporosis, which reduce bone remodelling and primarily prevent bone loss. Since these drugs reduce but do not eliminate risk of fractures, an anabolic agent that would increase bone mass and potentially cure the underlying skeletal problem is needed.
We did a 3-year randomised controlled trial to find out the effects of 1–34 human parathyroid hormone (hPTH [1–34], 400 U/25 μg daily subcutaneously) in postmenopausal women with osteoporosis taking hormone-replacement therapy (n=17). The controls were women taking hormone-replacement therapy only (n=17). The primary outcome was bone-mineral density of the lumbar vertebrae, with bone-mineral density at other sites and vertebral fractures as secondary endpoints.
Patients taking hormone-replacement therapy and PTH (1–34) had continuous increase in vertebral bone-mineral density during the 3 years, whereas there was no significant change in the control group. The total increase in vertebral bone-mineral density was 13·0% (p<0·001); 2·7% at the hip (p=0·05); and 8·0% in total-body bone mineral (p=0·002). No loss of bone mass was found at any skeletal site. Increased bone mass was associated with a reduction in the rate of vertebral fractures, which was significant when fractures were taken as a 15% reduction in vertebral height (p=0·04). During the first 6 months of treatment, serum osteocalcin concentration, which reflects bone formation, increased by more than 55%, whereas excretion of crosslinked n-telopeptide, which reflects bone resorption, increased by only 20%, which suggests some uncoupling of bone formation and resorption. By 6 months, there were similar increases in both markers, which gradually returned towards baseline as the study progressed. Vertebral bone-mineral density increased most during the first year of PTH treatment.
We found that PTH has a pronouned anabolic effect on the central skeleton in patients on hormone-replacement therapy. PTH also increases total-body bone mineral, with no detrimental effects at any skeletal site. The increased vertebral mass was associated with a reduced rate of vertebral fracture, despite increased bone turnover. Bone-mass changes may be consistent with a reduction in all osteoporotic fractures. If confirmed in larger studies, these data have important implications for the treatment of postmenopausal osteoporosis.</description><subject>Absorptiometry, Photon</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Biomarkers - analysis</subject><subject>Bone Density - drug effects</subject><subject>Bones</subject><subject>Drug therapy</subject><subject>Estrogen Replacement Therapy</subject><subject>Estrogens - therapeutic use</subject><subject>Female</subject><subject>Fractures, Bone - epidemiology</subject><subject>Fractures, Bone - prevention & control</subject><subject>Hormones</subject><subject>Hormones. Endocrine system</subject><subject>Humans</subject><subject>Incidence</subject><subject>Medical sciences</subject><subject>Menopause</subject><subject>Middle Aged</subject><subject>Osteoporosis</subject><subject>Osteoporosis, Postmenopausal - drug therapy</subject><subject>Osteoporosis, Postmenopausal - physiopathology</subject><subject>Pharmacology. Drug treatments</subject><subject>Postmenopause</subject><subject>Spine</subject><subject>Teriparatide - pharmacology</subject><subject>Teriparatide - therapeutic use</subject><subject>Women</subject><issn>0140-6736</issn><issn>1474-547X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkU2LFDEQhoMo67j6ExaCiOihNUmnk-mTyOIXLAh-gLeQTio7Wbo7bdK9y_wff6jVO8McvHhKJfXUm6p6Cbng7A1nXL39zrhkldK1etXq10zUUlTbB2TDpZZVI_Wvh2RzQh6TJ6XcMMakYs0ZOWvFVmqtN-TPNzv6NMQCnro0zjn1PYZlXvyepkAhBHDzGk0223m3zyl6ukt5SCPQNNJbyDN02fZVt74MthSKkjRk6-YlA42jix5GB9RizTWdUpkHGNNkl2J7epfwsgolKPj7NV7u4ryjSEGaUk4llqfkUbB9gWfH85z8_Pjhx-Xn6urrpy-X768qJ1U9VxwH1cqCDhaU7FTrXNdKxrZtwzpvm9BwziHYTtetaGqlmNCI-U5472sI9Tl5edCdcvq9YD8GF-Og7-0IaSlGt0JpoRiCz_8Bb9KSR-zN8LZlddNsOULNAXI4RMkQzJTjYPPecGZWC829hWb1x7Ta3Ftotlh3cRRfugH8qeroGeZfHPO2ONvjonHD5YQJZLhQiL07YIAbu42QTXFx9cHHjJYan-J_GvkLMjy8sg</recordid><startdate>19970823</startdate><enddate>19970823</enddate><creator>Lindsay, Robert</creator><creator>Nieves, Jeri</creator><creator>Formica, Carmelo</creator><creator>Henneman, Emily</creator><creator>Woelfert, Lillian</creator><creator>Shen, Victor</creator><creator>Dempster, David</creator><creator>Cosman, Felicia</creator><general>Elsevier Ltd</general><general>Lancet</general><general>Elsevier Limited</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>0TT</scope><scope>0TZ</scope><scope>0U~</scope><scope>3V.</scope><scope>7QL</scope><scope>7QP</scope><scope>7RV</scope><scope>7TK</scope><scope>7U7</scope><scope>7U9</scope><scope>7X7</scope><scope>7XB</scope><scope>88A</scope><scope>88C</scope><scope>88E</scope><scope>88G</scope><scope>88I</scope><scope>8AF</scope><scope>8AO</scope><scope>8C1</scope><scope>8C2</scope><scope>8FE</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>ASE</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BEC</scope><scope>BENPR</scope><scope>BHPHI</scope><scope>C1K</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FPQ</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>H94</scope><scope>HCIFZ</scope><scope>K6X</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>KB~</scope><scope>LK8</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>M2P</scope><scope>M7N</scope><scope>M7P</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>S0X</scope><scope>7X8</scope></search><sort><creationdate>19970823</creationdate><title>Randomised controlled study of effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis</title><author>Lindsay, Robert ; Nieves, Jeri ; Formica, Carmelo ; Henneman, Emily ; Woelfert, Lillian ; Shen, Victor ; Dempster, David ; Cosman, Felicia</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c463t-173676ae7fae64b69ccb94008950bda5f5111efab739253660274b6db2ddd3ef3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Absorptiometry, Photon</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Biomarkers - analysis</topic><topic>Bone Density - drug effects</topic><topic>Bones</topic><topic>Drug therapy</topic><topic>Estrogen Replacement Therapy</topic><topic>Estrogens - therapeutic use</topic><topic>Female</topic><topic>Fractures, Bone - epidemiology</topic><topic>Fractures, Bone - prevention & control</topic><topic>Hormones</topic><topic>Hormones. Endocrine system</topic><topic>Humans</topic><topic>Incidence</topic><topic>Medical sciences</topic><topic>Menopause</topic><topic>Middle Aged</topic><topic>Osteoporosis</topic><topic>Osteoporosis, Postmenopausal - drug therapy</topic><topic>Osteoporosis, Postmenopausal - physiopathology</topic><topic>Pharmacology. Drug treatments</topic><topic>Postmenopause</topic><topic>Spine</topic><topic>Teriparatide - pharmacology</topic><topic>Teriparatide - therapeutic use</topic><topic>Women</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Lindsay, Robert</creatorcontrib><creatorcontrib>Nieves, Jeri</creatorcontrib><creatorcontrib>Formica, Carmelo</creatorcontrib><creatorcontrib>Henneman, Emily</creatorcontrib><creatorcontrib>Woelfert, Lillian</creatorcontrib><creatorcontrib>Shen, Victor</creatorcontrib><creatorcontrib>Dempster, David</creatorcontrib><creatorcontrib>Cosman, Felicia</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>News PRO</collection><collection>Pharma and Biotech Premium PRO</collection><collection>Global News & ABI/Inform Professional</collection><collection>ProQuest Central (Corporate)</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Virology and AIDS Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Biology Database (Alumni Edition)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Psychology Database (Alumni)</collection><collection>Science Database (Alumni Edition)</collection><collection>STEM Database</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Lancet Titles</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>British Nursing Index</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>eLibrary</collection><collection>ProQuest Central</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>SciTech Premium Collection</collection><collection>British Nursing Index</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Newsstand Professional</collection><collection>ProQuest Biological Science Collection</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Psychology Database</collection><collection>Research Library</collection><collection>Science Database</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Biological Science Database</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest One Psychology</collection><collection>ProQuest Central Basic</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Lindsay, Robert</au><au>Nieves, Jeri</au><au>Formica, Carmelo</au><au>Henneman, Emily</au><au>Woelfert, Lillian</au><au>Shen, Victor</au><au>Dempster, David</au><au>Cosman, Felicia</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Randomised controlled study of effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>1997-08-23</date><risdate>1997</risdate><volume>350</volume><issue>9077</issue><spage>550</spage><epage>555</epage><pages>550-555</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Small increases in bone mass are commonly seen with existing treatments for osteoporosis, which reduce bone remodelling and primarily prevent bone loss. Since these drugs reduce but do not eliminate risk of fractures, an anabolic agent that would increase bone mass and potentially cure the underlying skeletal problem is needed.
We did a 3-year randomised controlled trial to find out the effects of 1–34 human parathyroid hormone (hPTH [1–34], 400 U/25 μg daily subcutaneously) in postmenopausal women with osteoporosis taking hormone-replacement therapy (n=17). The controls were women taking hormone-replacement therapy only (n=17). The primary outcome was bone-mineral density of the lumbar vertebrae, with bone-mineral density at other sites and vertebral fractures as secondary endpoints.
Patients taking hormone-replacement therapy and PTH (1–34) had continuous increase in vertebral bone-mineral density during the 3 years, whereas there was no significant change in the control group. The total increase in vertebral bone-mineral density was 13·0% (p<0·001); 2·7% at the hip (p=0·05); and 8·0% in total-body bone mineral (p=0·002). No loss of bone mass was found at any skeletal site. Increased bone mass was associated with a reduction in the rate of vertebral fractures, which was significant when fractures were taken as a 15% reduction in vertebral height (p=0·04). During the first 6 months of treatment, serum osteocalcin concentration, which reflects bone formation, increased by more than 55%, whereas excretion of crosslinked n-telopeptide, which reflects bone resorption, increased by only 20%, which suggests some uncoupling of bone formation and resorption. By 6 months, there were similar increases in both markers, which gradually returned towards baseline as the study progressed. Vertebral bone-mineral density increased most during the first year of PTH treatment.
We found that PTH has a pronouned anabolic effect on the central skeleton in patients on hormone-replacement therapy. PTH also increases total-body bone mineral, with no detrimental effects at any skeletal site. The increased vertebral mass was associated with a reduced rate of vertebral fracture, despite increased bone turnover. Bone-mass changes may be consistent with a reduction in all osteoporotic fractures. If confirmed in larger studies, these data have important implications for the treatment of postmenopausal osteoporosis.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>9284777</pmid><doi>10.1016/S0140-6736(97)02342-8</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0140-6736 |
| ispartof | The Lancet (British edition), 1997-08, Vol.350 (9077), p.550-555 |
| issn | 0140-6736 1474-547X |
| language | eng |
| recordid | cdi_proquest_miscellaneous_79267260 |
| source | MEDLINE; Elsevier ScienceDirect Journals Complete; EBSCOhost Business Source Complete; ProQuest Central UK/Ireland |
| subjects | Absorptiometry, Photon Aged Biological and medical sciences Biomarkers - analysis Bone Density - drug effects Bones Drug therapy Estrogen Replacement Therapy Estrogens - therapeutic use Female Fractures, Bone - epidemiology Fractures, Bone - prevention & control Hormones Hormones. Endocrine system Humans Incidence Medical sciences Menopause Middle Aged Osteoporosis Osteoporosis, Postmenopausal - drug therapy Osteoporosis, Postmenopausal - physiopathology Pharmacology. Drug treatments Postmenopause Spine Teriparatide - pharmacology Teriparatide - therapeutic use Women |
| title | Randomised controlled study of effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-02T10%3A30%3A03IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Randomised%20controlled%20study%20of%20effect%20of%20parathyroid%20hormone%20on%20vertebral-bone%20mass%20and%20fracture%20incidence%20among%20postmenopausal%20women%20on%20oestrogen%20with%20osteoporosis&rft.jtitle=The%20Lancet%20(British%20edition)&rft.au=Lindsay,%20Robert&rft.date=1997-08-23&rft.volume=350&rft.issue=9077&rft.spage=550&rft.epage=555&rft.pages=550-555&rft.issn=0140-6736&rft.eissn=1474-547X&rft.coden=LANCAO&rft_id=info:doi/10.1016/S0140-6736(97)02342-8&rft_dat=%3Cproquest_cross%3E13932262%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=199035581&rft_id=info:pmid/9284777&rft_els_id=S0140673697023428&rfr_iscdi=true |