| August 2006
Osteoporosis Canada's clinical practice guidelines for the use of parathyroid
hormone (PTH) for the treatment of osteoporosis, as well as a review paper on
PTH were published in the 'Commentary' and 'Review' sections respectively of the
July 4 issue of the Canadian Medical Association Journal (CMAJ). Both papers
were authored by consultants on OC's Scientific Advisory Council.
"We continue to review and expand our clinical practice guidelines as new
treatments are approved and studies on their effectiveness are completed," said
Karen Ormerod, President and CEO of Osteoporosis Canada. "This is essential work
if we are to advise health professionals on the best care for people with
osteoporosis. We are very grateful to the members of our Scientific Advisory
Council, particularly those on the clinical guidelines committee and all of the
authors involved, for their time and dedication in completing these most recent
guidelines for the use of PTH."
Highlights of the PTH Guidelines' recommendations include the following:
- PTH is recommended as a first-line therapy for women
65 years or older who have vertebral fractures and low BMD (T-score less than
or equal to -2.5). Ideally, patients selected for PTH treatment should not
have been taking a bisphosphonate.
- On a cost-effectiveness basis, PTH should be reserved
for the most severely affected patients (those with more than one fragility
fracture and very low BMD).
- Other potential candidates for PTH therapy include
postmenopausal women with very low BMD (less than or equal to -3.5) and those
who continue to have fragility fractures despite using a bisphosphonate (for
at least two years).
- PTH is a second-line therapy for men 65 years or
older who have severe osteoporosis and fragility fractures or patients who are taking
long-term corticosteroid therapy and have corticosteroid-induced osteoporosis and prevalent fractures.
- Bisphosphonates should be discontinued before
starting therapy with PTH. Following PTH therapy, an anti-resorptive agent is
recommended to maintain or increase BMD.
- PTH therapy should be limited to a maximum of 18
months.
- Supplemental calcium intake should be limited to 500
mg. per day to minimize the risk of hypercalcemia. Vitamin D supplements of
800 IU per day are recommended.
- Serum calcium levels should be monitored.
- PTH should not be used in children, adolescents, and people with a history
of skeletal irradiation or Paget's disease. It should be avoided in patients
with primary hyperparathyroidism, renal impairment or vitamin D deficiency. It
should be used with caution in people with a history of gout.
For the full text of the two CMAJ publications on PTH treatment for
osteoporosis, visit the CMAJ Web site at: www.cmaj.ca/cgi/content/full/175/1/48
and www.cmaj.ca/cgi/content/full/175/1/52.
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