1. Chapter 85 Chapter 85 Parathyroid Hormone Treatment for Osteoporosis Copyright © 2013 Elsevier Inc. All rights reserved.

2. FIGURE 85.1 A, lumbar spine (LS) bone mineral density (BMD) mean percentage change from baseline (±standard error (SE)). After 24 weeks of daily administration, all active treatment groups produced increases in LS BMD (p < 0.001) with no significant change in the placebo (Pbo-P) group. B, total hip BMD mean percentage change from baseline (±SE). *, after 24 weeks of daily treatment, the teriparatide (TPTD-P) 40-μg group increased hip BMD (p < 0.05) compared with Pbo-P. Source: from Cosman etal. (2010) [37]. 2

3. Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 85.2 LSM percentage change in bone mineral density (BMD) from baseline at lumbar spine (A), total hip (B), femoral neck (C), and femoral trochanter (D) according to treatment. a p < 0.001 versus teriparatide (TPTD) alone and versus zoledronic acid (ZOL) alone; b p < 0.001 versus ZOL alone; c p < 0.05 versus TPTD alone; d p < 0.05 versus ZOL alone. Data are from intent-to-treat population excluding missing values. Bars show standard error. Source: from Cosman et al. (2011) [43]. 3

4. Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 85.3 Median changes in indexes of bone formation (panels A, B, and C) and resorption (panel D) among the group given daily parathyroid hormone plus alendronate, the group given cyclic parathyroid hormone plus alendronate, and the group given alendronate alone. Error bars denote the interquartile range. p values are for the time–treatment interactions among the three groups. To convert values for osteocalcin to nanomoles per liter, multiply by 0.1724. Source: from Cosman etal. (2005) [18]. 4

5. Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 85.4 Percentage change in dual-energy X-ray absorptiometry (DXA) bone mineral density (BMD) from baseline. A, lumbar spine; B, total hip, by treatment group. Left panel shows prior alendronate groups, and right panel shows prior Raloxifene groups. §, p < 0.05; and §, p < 0.01 for difference between the groups within the alendronate or raloxifene stratum. Values are mean ± standard error (SE). Source: from Cosman et al. (2009) [50]. 5

6. Copyright © 2013 Elsevier Inc. All rights reserved. FIGURE 85.5 Time to radiographic healing in three of four cortices. Vertical lines indicate time (weeks) when median healing was achieved in the placebo, teriparatide 20 μg, and teriparatide 40 μg groups. Time to radiographic healing in all patients. Overall p = 0.015. 95% confidence interval (CI) for reduction of median healing time teriparatide 40 μg versus placebo: –1.1 To 0.6 weeks, p = 0.523; teriparatide 20 μg versus placebo: –2.7 to 0.6 weeks, p = 0.006; teriparatide 40 mg versus teriparatide 20 μg: –2.7 to 0.1 weeks, p = 0.053. Source: from Aspenberg etal. (2010) [67]. 6