MD Conference Express - ENDO 2015 - (Page 19)

SElECTED UPDATES Novel Approaches to the Treatment of Osteoporosis Written by Toni Rizzo The parathyroid hormone (1-34) [PTH(1-34)], teriparatide, is the only anabolic agent approved in the United States. PTH(1-34) stimulates bone formation, but it also stimulates bone resorption, limiting its anabolic effect. Teriparatide reduces fractures and increases bone mineral density (BMD) but is associated with hypercalcemia and hypercalciuria. According to Mara J. Horwitz, MD, University of Pittsburgh, Pittsburgh, Pennsylvania, USA, in phase 1 studies, parathyroid hormone-related protein (1-36) [PTHrP(1-36)] increased markers of bone formation but had little effect on bone resorption and did not cause hypercalcemia. The phase 2 PrOP study randomized 105 postmenopausal women to PTHrP(1-36), 400 µg/d; PTHrP(1-36), 600 µg/d; or PTH(1-34), 20 µg/d [Horwitz MJ et al. J Bone Miner Res. 2013]. There was a very early significant increase in aminoterminal propeptide of procollagen 1 (P1NP), a marker of bone formation, in all 3 groups, but by day 90, the increase in the PTH(1-34) group was significantly greater than in the PTHrP(1-36) groups. The increase in the bone resorption marker carboxyterminal telopeptides of collagen 1 (CTX) was delayed, with an increase in the PTH(1-34) group at day 60 and the PTHrP(1-36) groups at day 90 (Figure 1). Figure 1. PrOP Study: Change From Baseline in P1NP and CTX A 200 P1NP Official Peer-reviewed Highlights From 150 † * 100 # Change From Baseline (%) 50 * † * † March 5-8, 2015 San Diego, CA, USA * 0 B * < 0.0005 † < 0.05 # < 0.005 200 CTX 150 PTHrP 400 PTHrP 600 PTH 100 † 50 0 0 15 30 45 60 75 90 Days CTX, carboxy-terminal telopeptides of collagen 1; P1NP, amino-terminal telopeptides of procollagen 1. *P < .0005 #P < .005 †P < .05 Reprinted from J Bone Miner Res, Horowitz MJ et al, A comparison of parathyroid hormone-related protein (1-36) and parathyroid hormone (1-34) on markers of bone turnover and bone density in postmenopausal women: The PrOP study, 2013;28(11):2266-2276, Copyright © with permission from American Society for Bone and Mineral Research. Official Peer-Reviewed Highlights From ENDO 2015 19

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MD Conference Express - ENDO 2015