PTH analogue

Teriparatide is the first 34 amino acids of human parathyroid hormone, and it is the odd one out in this group: a licensed medicine with a fracture-outcome trial behind it. Parathyroid hormone continuously elevated - as in hyperparathyroidism - destroys bone. Given as a single daily injection it does the opposite and builds it, which is one of the more surprising dose-schedule effects in pharmacology. The pivotal trial randomised 1637 postmenopausal women with prior vertebral fractures: new vertebral fractures occurred in 14% on placebo against 5% and 4% on 20 µg and 40 µg. VERO later compared it head to head with risedronate in severe osteoporosis and found new vertebral fractures in 5.4% against 12.0%, a hazard ratio of 0.44. It is included here because it is a peptide bioregulator in the literal sense - and because it shows what the rest of this group's evidence would look like if it existed.