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Teriparatide is a recombinant form of parathyroid hormone consisting of the first (N-terminus) 34 amino acids, which is the bioactive portion of the hormone. It is an effective anabolic agent used in the treatment of some forms of osteoporosis. It is also occasionally used off-label to speed fracture healing. Teriparatide is identical to a portion of human parathyroid hormone (PTH) and intermittent use activates osteoblasts more than osteoclasts, which leads to an overall increase in bone.
In pseudohypoparathyroidism there is a resistance to the action of the parathormone in its target organs. Patients with this disease show clinical and laboratory data of hypoparathyroidism with normal or high levels of parathormone. Three types of pseudohypoparathyroidism are known according to the site in which the disorder is localized, within the complex formed by the cell receptor for the hormone and the adenylate cyclase systems of the cell membrane: Ia, Ib and II. The response of plasmatic and urinary cyclic AMP to the administration of parathyroid hormone may be useful to establish the type of pseudohypoparathyroidism presented in determined patients. Three cases of pseudohypoparathyroidism in whom an intravenous stimulation test with the synthetic 1-34 fragment of the human parathormone [teriparatid acetate (PARATHAR)] are presented. These patients were diagnosed according to the responses of cyclic AMP of type I pseudohypoparathyroidism. The methodology followed for the study and the results obtained are commented.
Rius, F., Salinas, I., Reverter, J. L., Pizarro, E., & Lucas, A. (1993). The usefulness of the teriparatide acetate (Parathar) infusion test in the diagnosis of pseudohypoparathyroidism. Medicina clinica, 101(8), 303-305.
In this pilot study, teriparatide therapy in patients with postthyroidectomy hypoparathyroidism was safe, rapidly eliminated hypocalcemic symptoms, and likely reduced the duration of hospitalization. Given the limitations of this small study, a large-scale randomized trial is needed to verify these results and to assess the long-term effect of teriparatide therapy on clinical outcomes.
Shah, M., Bancos, I., Thompson, G. B., Richards, M. L., Kasperbauer, J. L., Clarke, B. L., ... & Stan, M. N. (2015). Teriparatide therapy and reduced postoperative hospitalization for postsurgical hypoparathyroidism. JAMA Otolaryngology–Head & Neck Surgery, 141(9), 822-827.
Teriparatide acetate was developed in the form of a synthetic analogue of the Nterminal peptide (1-34) of human parathyroid hormone for the treatment of osteoporosis; it is administered subcutaneously once weekly. However, it is not known whether the pharmacokinetics (PK) of this drug is affected by renal impairment, and this study was conducted to look into this question.
Imai, H., Watanabe, M., Fujita, T., Watanabe, H., Harada, K., & Moritoyo, T. (2014). Pharmacokinetics of teriparatide after subcutaneous administration to volunteers with renal failure: a pilot study. International journal of clinical pharmacology and therapeutics, 52(2), 166-174.