Comments on Bang et al.: The impact of recombinant parathyroid hormone on malignancies and mortality: 7 years of experience based on nationwide Danish registers
An article by U. C. Bang, L. Hyldstrup, and J. E. B. Jensen in the February 2014 issue of Osteoporosis International evaluated the incidence of cancer and mortality in osteoporotic patients treated with recombinant parathyroid hormone analogs (rPTH), including the incidence of osteosarcoma, a rare bone cancer . The evaluation of osteosarcoma is particularly important because of the prior finding of an increased risk of primary osteosarcoma in rats treated with rPTH [2–4]. We have been researching this topic in humans through epidemiologic studies of teriparatide since 2002, including a study referenced in the article.
We need to highlight a key methodologic problem in the Bang et al. research because it has important implications for future epidemiologic studies of osteosarcoma. The outcome measure evaluated by the investigators as reported in the paper bears little relationship to primary osteosarcoma, the subject of the rPTH signal. The study used ICD-10 codes C40-C41 ( ...