Background/Purpose: Although glucocorticoid-induced osteoporosis is the most common cause of secondary osteoporosis, providing effective treatment remains a challenge. Bisphosphonates are currently recommended for treatment and prevention of glucocorticoid-induced osteoporosis in several international guidelines. However, some people cannot tolerate any of the available bisphosphonate therapy because of their adverse effects. Moreover, bone resorption is inhibited with bisphosphonates, while the primary action of glucocorticoids is to decrease bone formation. On the other hand, human parathyroid hormone (hPTH) stimulates bone formation. As a result, hPTH may have significant advantages for treatment and prevention of glucocorticoid-induced osteoporosis. To the best of our knowledge, this topic has not yet been systematically reviewed. We therefore examine the benefit and harm of hPTH in the prevention and treatment of glucocorticoid-induced osteoporosis.

Methods: We searched three different databases (Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE) as well as reference lists of retrieved studies and review articles published between January 1966 and October 2014. All relevant randomized controlled trials that assess the efficacy of hPTH for the prevention or treatment of glucocorticoid-induced osteoporosis were included. All papers meeting strict inclusion criteria were scrutinized for data on population size, participants characteristics, vertebral fracture, non-vertebral fractures, bone mineral density (BMD) at the lumber spine, withdrawals due to adverse events, serious adverse events.

Results: A total of 1,784 articles were initially identified and 414 of these articles were duplicates and therefore excluded. After the initial screening, 20 full-length articles were selected for detailed analysis on the basis of title or abstract. Eventually, four studies (17 articles) met all the inclusion criteria. Two studies compared hPTH with bisphosphonate while the other studies assessed the efficacy of hPTH comparing with placebo or no treatment. A total of 595 patients were covered by these studies, with women accounting for a median of 52.7 percent and the median of the mean age was 56.7 years. We could not pool data on the vertebral fracture or non-vertebral fracture because there were no fractures in one study that compared hPTH with bisphosphonate, while the other showed fewer vertebral fractures in hPTH than in bisphosphonate (P =0.004) whereas the incidence of non-vertebral fractures was similar (P = 0.36). Patients in hPTH had an greater increase in change from baseline in BMD at lumber spine than patients in bisphosphonate (pooled percentage change: 3.77: 95% confidence interval: 1.99-5.56).The pooled analysis showed fewer withdrawals due to adverse events in hPTH than bisphosphonate (odds ratio (OR): 0.45, 95% confidence interval: 0.24-0.86) while that for serious adverse events was similar (OR: 0.80, 95% confidence interval: 0.32-2.00).

Conclusion:  hPTH seems to be more effective than bisphosphonate.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/human-parathyroid-hormone-for-preventing-and-treating-glucocorticoid-induced-osteoporosis-cochrane-systematic-review-and-meta-analysis/