甲狀旁腺激素預防和治療絕經后骨質疏松癥療效的系統評價_《中國循證醫學雜志》

作者：

褚加成 ¹ , 李劍 ¹ ,  歐陽玲莉 ¹ , 吳泰相 ²

1. 廣西醫科大學第一附屬醫院（南寧 530021）；2. 四川大學華西醫院中國循證醫學中心，中國臨床試驗注冊中心，INCLEN CERTC（成都 610041）;

關鍵詞：

甲狀旁腺激素骨質疏松癥絕經后系統評價

DOI：

10.7507/1672-2531.20080194

視頻：

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目的　系統評價甲狀旁腺激素（PTH）預防和治療絕經后骨質疏松癥的療效和安全性。
方法　計算機檢索MEDLINE（1966 ～ 2008.3）、EMBASE（1974 ～ 2008.3）、Cochrane 圖書館臨床試驗資料庫（2008 年第1 期）、Current Controlled Trials、The National Reseach Register、中國生物醫學文獻數據庫（1983 ～ 2008.3）、中國期刊全文數據庫（1994 ～ 2008.3），并手工檢索相關領域其它雜志。檢索不受語種限制，時間截至2008年3月。納入以患原發性質疏松癥或骨量減少的絕經后女性為研究對象、比較甲狀旁腺激素與其它療法療效的隨機對照試驗，評價納入研究的質量，并用RevMan 4.2.10 軟件進行Meta 分析。
結果　共納入12個隨機對照試驗，包括5 550例患者。Meta分析結果顯示：PTH單用或與其它藥物聯用與對照組比較，減少椎體骨折風險達66%［RR=0.34，95%CI（0.26，0.45），P lt;0.000 01］；增加腰椎［SMD=0.41，95%CI( 0.19，0.63)，P=0.000 3］和股骨頸［SMD=0.19，95%CI（0.10，0.28），P lt;0.000 1］的骨密度優于對照組。PTH 發生副作用導致的退出和失訪多于對照組［Peto-OR=1.69，95%Cl( 1.39，2.05），P lt;0.000 01］。
結論　 PTH 預防和治療絕經后骨質疏松癥療效肯定，能提高腰椎及股骨頸的骨密度，降低椎體骨折的風險。PFH對絕經后骨質疏松癥的療效優于阿倫磷酸鹽，但不宜和阿倫磷酸鹽聯合使用，骨量嚴重低下和有骨質疏松性骨折的絕經后女性是PTH較適合的人群。

引用本文： 褚加成,李劍,歐陽玲莉,吳泰相. 甲狀旁腺激素預防和治療絕經后骨質疏松癥療效的系統評價. 中國循證醫學雜志, 2008, 08(10): 879-886. doi: 10.7507/1672-2531.20080194 復制

1.	Moayyeri A, Soltani A, Bahrami H, et al. Preferred skeletal site for osteoporosis screening in high-risk populations. public health, 2006, 120(9): 863-871.
2.	Report of a WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report Series, 1994, 843.
3.	Kanis JA, Melton LJⅢ, Christiansea C, et al. The diagnosis of osteoporosis. J Bone Miner Res, 1994, 9: 1137-1141.
4.	Report of a WHO Scientific Group. Prevention and Management of Osteoporosis. WHO Technical Report Series, 2003, 921.
5.	WANG Hong-fu. Diagnosis of osteoporosis. Intern J Endocrinol Metab, 2006, 26: 285-288.(in chinese).
6.	Doggrell SA. Recent important clinical trials of drugs in osteoporosis. Expert Opin Pharmacother, 2004, 5(7): 1635.
7.	ZHANG Jun, GE Ning, HUANG Xiao-li, et al. Review of drug treatment for osteoporosis. Chinese journal of practical internal medicine, 2006, 26(4): 313-315.(in chinese).
8.	Vestergaard P, Jorgensen N, et al. Effects of parathyroid hormone alone or in combination with antiresorptive therapy on bone mineral density and fracture risk-a meta-analysis. Osteoporos Int, 2007, 18: 45-47.
9.	吳泰相, 劉關鍵. 隱蔽分組(分配隱藏)和盲法的概念、實施與報告. 中國循證醫學雜志, 2007, 7(3): 222-225.
10.	Black DM, Bouxsein ML, Palermo L, et al. Randomized Trial of Once-Weekly PTH (1-84) on Bone Mineral Density and Remodeling. J Clin Endocrin Metab, 2008, 2007-2781.
11.	Cosman F, Nieves JW, Zion M, et al. Effect of prior and ongoing raloxifene therapy on response to PTH and maintenance of BMD after PTH therapy. Osteoporos Int, 2008, 19(4): 529-535.
12.	Greenspan SL, Bone HG, Ettinger MP, et al. Effect of recombinant human parathyroid hormone (1-84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis: a randomized trial. Ann Intern Med, 2007, 146(5): 326-339.
13.	Gonnelli S, Martini G, Caffarelli C, et al. Teriparatide’s effects on quantitative ultrasound parameters and bone density in women with established osteoporosis. Osteoporos Int, 2006, 17(10): 1524-1531.
14.	Ste-Marie LG, Schwartz SL, Hossain A, et al. Effect of teriparatide [rhPTH(1-34)] on BMD when given to postmenopausal women receiving hormone replacement therapy. J Bone Miner Res, 2006, 21(2): 283-291.
15.	Cosman F, Nieves J, Zion M, et al. Daily and cyclic parathyroid hormone in women receiving alendronate. N Engl J Med, 2005, 353: 566-575.
16.	McClung MR, San Martin J, Miller PD, et al. Opposite bone remodeling effects of teriparatide and alendronate in increasing bone mass. Arch Intern Med, 2005, 165: 1762-1768.
17.	Hodsman AB, Hanley DA, Ettinger MP, et al. Efficacy and safety of human parathyroid hormone-(1-84) in increasing bone mineral density in postmenopausal osteoporosis. J Clin Endocrinol Metab, 2003, 88: 5212-5220.
18.	Black DM, Greenspan SL, Ensrud KE, et al. The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. N Engl J Med, 2003, 349: 1207-1215.
19.	Body JJ, Gaich GA, Scheele WH, et al. A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1-34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab, 2002, 87: 4528-4535.
20.	Cosman F, Nieves J, Woelfert L, et al. Parathyroid hormone added to established hormone therapy: effects on vertebral fracture and maintenance of bone mass after parathyroid hormone withdrawal. J Bone Miner Res, 2001, 16: 925-931.
21.	Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med, 2001, 344: 1434-1441.
22.	Hodsman AB, Bauer DC, Dempster DW, et al. Parathyroid Hormone and Teriparatide for the Treatment of Osteoporosis: A Review of the Evidence and Suggested Guidelines for Its Use. Endocrine Reviews, 2005, 26(5): 688-703.
23.	Vahle JL, Sato M, Long GG, et al. Skeletal changes in rats given daily subcutaneous injections of recombinant human parathyroid hormone(1-34) for 2 years and relevance to human safety. Toxicol Pathol, 2002, 30: 312-321.

1. Moayyeri A, Soltani A, Bahrami H, et al. Preferred skeletal site for osteoporosis screening in high-risk populations. public health, 2006, 120(9): 863-871.
2. Report of a WHO Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. WHO Technical Report Series, 1994, 843.
3. Kanis JA, Melton LJⅢ, Christiansea C, et al. The diagnosis of osteoporosis. J Bone Miner Res, 1994, 9: 1137-1141.
4. Report of a WHO Scientific Group. Prevention and Management of Osteoporosis. WHO Technical Report Series, 2003, 921.
5. WANG Hong-fu. Diagnosis of osteoporosis. Intern J Endocrinol Metab, 2006, 26: 285-288.(in chinese).
6. Doggrell SA. Recent important clinical trials of drugs in osteoporosis. Expert Opin Pharmacother, 2004, 5(7): 1635.
7. ZHANG Jun, GE Ning, HUANG Xiao-li, et al. Review of drug treatment for osteoporosis. Chinese journal of practical internal medicine, 2006, 26(4): 313-315.(in chinese).
8. Vestergaard P, Jorgensen N, et al. Effects of parathyroid hormone alone or in combination with antiresorptive therapy on bone mineral density and fracture risk-a meta-analysis. Osteoporos Int, 2007, 18: 45-47.
9. 吳泰相, 劉關鍵. 隱蔽分組(分配隱藏)和盲法的概念、實施與報告. 中國循證醫學雜志, 2007, 7(3): 222-225.
10. Black DM, Bouxsein ML, Palermo L, et al. Randomized Trial of Once-Weekly PTH (1-84) on Bone Mineral Density and Remodeling. J Clin Endocrin Metab, 2008, 2007-2781.
11. Cosman F, Nieves JW, Zion M, et al. Effect of prior and ongoing raloxifene therapy on response to PTH and maintenance of BMD after PTH therapy. Osteoporos Int, 2008, 19(4): 529-535.
12. Greenspan SL, Bone HG, Ettinger MP, et al. Effect of recombinant human parathyroid hormone (1-84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis: a randomized trial. Ann Intern Med, 2007, 146(5): 326-339.
13. Gonnelli S, Martini G, Caffarelli C, et al. Teriparatide’s effects on quantitative ultrasound parameters and bone density in women with established osteoporosis. Osteoporos Int, 2006, 17(10): 1524-1531.
14. Ste-Marie LG, Schwartz SL, Hossain A, et al. Effect of teriparatide [rhPTH(1-34)] on BMD when given to postmenopausal women receiving hormone replacement therapy. J Bone Miner Res, 2006, 21(2): 283-291.
15. Cosman F, Nieves J, Zion M, et al. Daily and cyclic parathyroid hormone in women receiving alendronate. N Engl J Med, 2005, 353: 566-575.
16. McClung MR, San Martin J, Miller PD, et al. Opposite bone remodeling effects of teriparatide and alendronate in increasing bone mass. Arch Intern Med, 2005, 165: 1762-1768.
17. Hodsman AB, Hanley DA, Ettinger MP, et al. Efficacy and safety of human parathyroid hormone-(1-84) in increasing bone mineral density in postmenopausal osteoporosis. J Clin Endocrinol Metab, 2003, 88: 5212-5220.
18. Black DM, Greenspan SL, Ensrud KE, et al. The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. N Engl J Med, 2003, 349: 1207-1215.
19. Body JJ, Gaich GA, Scheele WH, et al. A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1-34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab, 2002, 87: 4528-4535.
20. Cosman F, Nieves J, Woelfert L, et al. Parathyroid hormone added to established hormone therapy: effects on vertebral fracture and maintenance of bone mass after parathyroid hormone withdrawal. J Bone Miner Res, 2001, 16: 925-931.
21. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med, 2001, 344: 1434-1441.
22. Hodsman AB, Bauer DC, Dempster DW, et al. Parathyroid Hormone and Teriparatide for the Treatment of Osteoporosis: A Review of the Evidence and Suggested Guidelines for Its Use. Endocrine Reviews, 2005, 26(5): 688-703.
23. Vahle JL, Sato M, Long GG, et al. Skeletal changes in rats given daily subcutaneous injections of recombinant human parathyroid hormone(1-34) for 2 years and relevance to human safety. Toxicol Pathol, 2002, 30: 312-321.

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甲狀旁腺激素預防和治療絕經后骨質疏松癥療效的系統評價

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《中國循證醫學雜志》

甲狀旁腺激素預防和治療絕經后骨質疏松癥療效的系統評價

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