CRD Summary: This review concluded that human parathyroid hormone (1-34) used to treat osteoporosis in postmenopausal women with previous fractures is associated with significant increases in bone mineral density and a significant reduction in the risk of new fractures. The authors’ conclusions appear valid, but some caution is advised given the variability and small size of many of the studies.

[The studies included in the review evaluated doses of hPTH (1-34) usually ranging from 20 to 40 microg/day; studies of hPTH (1-84) used doses of 50 to 100 microg/day. Active comparators included alendronate, calcitonin and hormone replacement therapy (HRT). ]

CRD Commentary: This review answered a defined but rather broad review question, particularly in terms of the interventions and populations studied. A reasonable search for studies was carried out, but it is difficult to assess whether publication bias might have affected the findings. The authors also referred to a website for further details, but this was not accessible.  Appropriate methods were, however, used to reduce the risk of error and bias when selecting, quality assessing and extracting the data from the included studies. The methodological quality of the studies was also considered in the analysis, to indicate the reliability of the review findings. The decision to summarise the review findings in a narrative appears appropriate given the broad inclusion criteria and the resultant differences in drug types, dosages, comparators and patient populations.  Overall, the authors’ conclusions appear to be supported by the data presented, but some caution is advised given the level of heterogeneity and the small size of many of the studies.