Skip to main content
PMC home page
The BMJ logoLink to The BMJ
. 1990 Aug 11;301(6747):314–318. doi: 10.1136/bmj.301.6747.314

Treatment of osteoporosis with human parathyroid peptide and observations on effect of sodium fluoride.

J Reeve 1, U M Davies 1, R Hesp 1, E McNally 1, D Katz 1
PMCID: PMC1663613  PMID: 2393738

Abstract

OBJECTIVE--To evaluate the need for a randomised study of treatment of spinal osteoporosis with human parathyroid peptide in the secondary prevention of crush fractures; to study the effect of human parathyroid hormone peptide 1-34 plus sex hormones on vertebral body cancellous bone; and, separately, to determine the effect of relatively low doses of sodium fluoride plus calcium on spinal bone mineral density. DESIGN--Open study of patients with primary or postmenopausal osteoporosis. All patients had serial bone densitometry of the spine by quantitative computed tomography and dual photon absorptiometry as well as serial densitometry of the radial midshaft (cortical) and radial distal (trabecular) bone by quantitative computed tomography. Changes in the spinal bone not forming the spongiosa of the vertebral bodies ("cortical" bone) were determined from the difference between the two axial measurements, after correction to the same units of measurement. SETTING--Northwick Park Hospital and Medical Research Council Clinical Research Centre. PATIENTS--24 Patients who fulfilled the conventional criteria for type 1 (vertebral) osteoporosis not secondary to recognised causes other than sex hormone deficiency and with at least one crush or wedge vertebral fracture and a spinal bone density (quantitative computed tomography) less than 80 mg/cm3 or two or more fractures. Twelve patients received human parathyroid peptide and 12 sodium fluoride; they were not randomised. MAIN OUTCOME MEASURES--Trends in axial and peripheral bone mass values determined by linear, time dependent regression analyses. RESULTS--The patients receiving the peptide showed a substantial increase in vertebral spongiosa (mean 25.6 mg/cm2 two years after the start of treatment). No significant changes were seen in spinal cortical or radial bone density. The patients receiving sodium fluoride showed roughly equal increases in cancellous and cortical bone over the same period (mean increase in vertebral spongiosa 16.1 mg/cm3). No significant changes were seen in radial bone. CONCLUSIONS--Treatment of postmenopausal women with human parathyroid peptide selectively increases spinal cancellous bone density by amounts that may prove useful in secondary prevention. Peptide treatment should now be tested in a randomised study in which the important end point is prevention of fractures as the usefulness of sodium fluoride in this context is doubtful.

Full text

PDF
314

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Boivin G., Chavassieux P., Chapuy M. C., Baud C. A., Meunier P. J. Skeletal fluorosis: histomorphometric analysis of bone changes and bone fluoride content in 29 patients. Bone. 1989;10(2):89–99. doi: 10.1016/8756-3282(89)90004-5. [DOI] [PubMed] [Google Scholar]
  2. Briancon D., Meunier P. J. Treatment of osteoporosis with fluoride, calcium, and vitamin D. Orthop Clin North Am. 1981 Jul;12(3):629–648. [PubMed] [Google Scholar]
  3. Carter D. R., Beaupré G. S. Effects of fluoride treatment on bone strength. J Bone Miner Res. 1990 Mar;5 (Suppl 1):S177–S184. doi: 10.1002/jbmr.5650051372. [DOI] [PubMed] [Google Scholar]
  4. Genant H. K., Steiger P., Block J. E., Glueer C. C., Ettinger B., Harris S. T. Quantitative computed tomography: update 1987. Calcif Tissue Int. 1987 Oct;41(4):179–186. doi: 10.1007/BF02555236. [DOI] [PubMed] [Google Scholar]
  5. Geusens P., Dequeker J. Long-term effect of nandrolone decanoate, 1 alpha-hydroxyvitamin D3 or intermittent calcium infusion therapy on bone mineral content, bone remodeling and fracture rate in symptomatic osteoporosis: a double-blind controlled study. Bone Miner. 1986 Sep;1(4):347–357. [PubMed] [Google Scholar]
  6. Hesch R. D., Busch U., Prokop M., Delling G., Rittinghaus E. F. Increase of vertebral density by combination therapy with pulsatile 1-38hPTH and sequential addition of calcitonin nasal spray in osteoporotic patients. Calcif Tissue Int. 1989 Mar;44(3):176–180. doi: 10.1007/BF02556561. [DOI] [PubMed] [Google Scholar]
  7. Mamelle N., Meunier P. J., Dusan R., Guillaume M., Martin J. L., Gaucher A., Prost A., Zeigler G., Netter P. Risk-benefit ratio of sodium fluoride treatment in primary vertebral osteoporosis. Lancet. 1988 Aug 13;2(8607):361–365. doi: 10.1016/s0140-6736(88)92834-6. [DOI] [PubMed] [Google Scholar]
  8. Marie P. J., Caulin F. Mechanisms underlying the effects of phosphate and calcitonin on bone histology in postmenopausal osteoporosis. Bone. 1986;7(1):17–22. doi: 10.1016/8756-3282(86)90147-x. [DOI] [PubMed] [Google Scholar]
  9. Meunier P., Aaron J., Edouard C., Vignon G. Osteoporosis and the replacement of cell populations of the marrow by adipose tissue. A quantitative study of 84 iliac bone biopsies. Clin Orthop Relat Res. 1971 Oct;80:147–154. doi: 10.1097/00003086-197110000-00021. [DOI] [PubMed] [Google Scholar]
  10. Nordin B. E., Horsman A., Crilly R. G., Marshall D. H., Simpson M. Treatment of spinal osteoporosis in postmenopausal women. Br Med J. 1980 Feb 16;280(6212):451–454. doi: 10.1136/bmj.280.6212.451. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. O'Duffy J. D., Wahner H. W., O'Fallon W. M., Johnson K. A., Muhs J. M., Beabout J. W., Hodgson S. F., Riggs B. L. Mechanism of acute lower extremity pain syndrome in fluoride-treated osteoporotic patients. Am J Med. 1986 Apr;80(4):561–566. doi: 10.1016/0002-9343(86)90808-9. [DOI] [PubMed] [Google Scholar]
  12. Reeve J., Arlot M., Price T. R., Edouard C., Hesp R., Hulme P., Ashby J. P., Zanelli J. M., Green J. R., Tellez M. Periodic courses of human 1-34 parathyroid peptide alternating with calcitriol paradoxically reduce bone remodelling in spinal osteoporosis. Eur J Clin Invest. 1987 Oct;17(5):421–428. doi: 10.1111/j.1365-2362.1987.tb01137.x. [DOI] [PubMed] [Google Scholar]
  13. Reeve J., Meunier P. J., Parsons J. A., Bernat M., Bijvoet O. L., Courpron P., Edouard C., Klenerman L., Neer R. M., Renier J. C. Anabolic effect of human parathyroid hormone fragment on trabecular bone in involutional osteoporosis: a multicentre trial. Br Med J. 1980 Jun 7;280(6228):1340–1344. doi: 10.1136/bmj.280.6228.1340. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Riggs B. L., Hodgson S. F., O'Fallon W. M., Chao E. Y., Wahner H. W., Muhs J. M., Cedel S. L., Melton L. J., 3rd Effect of fluoride treatment on the fracture rate in postmenopausal women with osteoporosis. N Engl J Med. 1990 Mar 22;322(12):802–809. doi: 10.1056/NEJM199003223221203. [DOI] [PubMed] [Google Scholar]
  15. Rüegsegger P., Elsasser U., Anliker M., Gnehm H., Kind H., Prader A. Quantification of bone mineralization using computed tomography. Radiology. 1976 Oct;121(1):93–97. doi: 10.1148/121.1.93. [DOI] [PubMed] [Google Scholar]
  16. Slovik D. M., Rosenthal D. I., Doppelt S. H., Potts J. T., Jr, Daly M. A., Campbell J. A., Neer R. M. Restoration of spinal bone in osteoporotic men by treatment with human parathyroid hormone (1-34) and 1,25-dihydroxyvitamin D. J Bone Miner Res. 1986 Aug;1(4):377–381. doi: 10.1002/jbmr.5650010411. [DOI] [PubMed] [Google Scholar]

Articles from BMJ : British Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES