Review Article

PTH (1–34): A Novel Anabolic Drug for the Treatment of Osteoporosis

Authors: Michael F. Holick, MD, PHD


The management of osteoporosis has in the past included providing patients with an adequate source of calcium and vitamin D and consideration of some type of antiresorption therapy such as hormone replacement, SERM therapy, or bisphosphonate therapy. However, patients who have very low bone density and continue to have fractures while receiving these therapies need to consider being treated with the recently approved novel anabolic drug PTH (1–34) (Forteo). The osteoblast has the receptor for parathyroid hormone (PTH). When PTH (1–34) is given in a pulsatile fashion, for example a daily subcutaneous injection, it stimulates osteoblasts to make new bone. PTH (1–34) has been shown to markedly increase spinal bone density and increase hip bone density. In addition, the relative risk of having moderate vertebral fracture was reduced by 90. Thus, PTH (1–34) offers an exciting new approach for the treatment of severe osteoporosis.

Key Points

* Parathyroid hormone (PTH) is a novel anabolic drug for osteoporosis.

* PTH (1–34) (Forteo) is effective in reducing vertebral and nonvertebral fractures.

* PTH (1–34) has been approved for the treatment of osteoporosis in both women and men who failed therapies.

* There are essentially no side effects from PTH (1–34) therapy.

* There is a black box warning for PTH (1–34) that is based on the fact that rats given large doses of PTH (1–34) have an increased risk of osteosarcoma.

* There is no evidence that PTH (1–34) causes bone cancer in humans.

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