• Mechanism
  1. Recombinant Parathyroid Hormone
  2. Significant bone anabolic activity
  1. Women, postmenopausal, with severe bone loss
  2. Men with Osteoporosis and high risk of Fracture
  3. Osteoporosis refractory to Bisphosphonates
  • Preparations
  1. Abaloparatide (Tymlos)
    1. Dose: 80 mcg SQ daily for up to 2 years
  2. Teriparatide (Forteo)
    1. Dose 20 mcg SQ daily for up to 2 years
  3. Consider restarting bisphosphonate after Teriparatide course is completed
    1. Black (2005) N Engl J Med 353(6):555-65 [PubMed]
  • Efficacy
  • Teriparatide (Forteo)
  1. BMD increases 5.9% at spine and 1.5% at femoral neck
  2. Reduced risk for osteoporotic Fractures
    1. Neer (2001) N Engl J Med 344:1434-41 [PubMed]
  • Contraindications
  1. Hyperparathyroidism
  2. Osteomalacia
  3. End Stage Renal Disease
  4. Bone Cancer
  5. Active Nephrolithiasis
  6. Hypercalcemia
  7. Osteosarcoma risk
    1. Paget's Disease
    2. Prior skeletal radiation
    3. Elevated Alkaline Phosphatase level
  • Adverse Effects
  1. Common
    1. Orthostatic Hypotension
    2. Transient Hypercalcemia
    3. Nausea
    4. Headache
    5. Palpitations
    6. Arthralgias
    7. Leg Cramps
  2. Uncommon (identified in rat studies)
    1. Osteosarcoma
  • Precautions
  1. Do not use with bisphosphonate
  2. Use limited to 2 year maximum (due to risk of Osteosarcoma)
  3. Very expensive agents ($20,000 per year or more)
  • Resources
  1. National Osteoporosis Foundation Clinicians Guide To Osteoporosis
    1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9546973/
  • References
  1. (2017) Presc Lett 24(7)
  2. Campion (2003) Am Fam Physician 67(7):1521-6 [PubMed]
  3. Orwoll (2003) J Bone Miner Res 18:9-17 [PubMed]