ABSTRACT
I t m ust clearly be understood th at any P TH , such as h P T H -(l-3 4 ) (Forteo™ ), w ill never be used as a preven tative lik e the m uch cheaper antiresorptives(anti-catabolics). This, o f course does not please the marketers who love continuously given drugs, like the diabetics’ insulin or some future drug that must be given regularly to drain the Alzheimer patient’s brain o f the continu ously accumulating neuron-destroying β-amyloid protein, that produce a steady cash flow. Indeed, for example space travelers should not use an expensive P T H to maintain their bones during flight because weekly Fosamax™ would be a cheaper bone-maintaining agent. A P T H should used: (1) when a man or woman has a high risk o f fracture; (2) when the person has had an osteoporotic fracture; (3) when the person’s B M D is more than 3 standard deviations from the population mean; (4) when the person is o f an advanced age; (3) when the person cannot, or will not, take bisphosphonates; (6) when the person has had a fracture while being treated with a bisphosphonate. Currently the only available h P T H -(l-3 4 ) (Forteo™ ) will be used for no more than a couple years to restore severly deteriorated microarchitecture and lost bone strength and then turn the job over to an antiresorptive to protect the new “P T H bone” in postmenopausal women and men. It is also likely that the PTH s will be used for short periods to accelerate fracture mending not just in osteoporotics and space travelers, but in people o f all ages, especially children with their osteoblast-loaded, hence maximally PTH-responsive, bones (Koch, 2 001 ; Walker, 1971), and they should be used to strengthen the depleted bones o f astronauts returning from long space missions during which they had not been protected from bone loss in flight by taking an antiresorptive such as Fosamax™ . But the P T H s may be less effective or ineffective duting long space missions because o f a progressive loss o f the ability o f the osteoprogenitor cells, genomically unprimed by strain, in unloaded bone to respond to PTH-induced IG F-I (Bikle et al., 1994; Kostenuiket al., 1999)!The P T H s should also be able to strengthen bone eroded by arthritis. And last, but by no means least for aging populations, the PTH s will soon be accelerating the osteointegration, and later reversing any loosening, o f various orthopedic and dental implants (M..Allen et al., 2003 ; Kawane et al., 20 0 2 ; Shirota et al., 2 003 ; Skripitz and Aspenberg, 2001a, 2001b ; Skripitz et al.,200a, 200b).
