teriparatide (Forteo)
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Indications
- osteoporosis with high risk of fracture
Contraindications
- patients at risk for osteosarcoma
- Paget's disease of the bone
- skeletal radiation
- bone metastases
- hypercalcemia
Dosage
* osteoclast inhibition with bisphosphonate should be started within 1 month of teriparatide discontinuation to prevent rapid loss of new bone formation[4]
Pharmacokinetics
- anabolic on bone high initially, but declines after 1-2 years of treatment[2]
Adverse effects
- dizziness or tachycardia after injection
- less likely after 1st few doses
- supine position provides relief
- may increase risk of bone cancer (animal studies)
- hypercalcemia (6%)[5]
Mechanism of action
- human parathyroid hormone
- stimulates osteoblast activity & new bone growth
- reduces vertebral fractures by 65% & non-vertebral fractures by 53% in women with prior vertebral fractures[6]
- teriparatide reduces vertebral fracture vs alendronate at incremental cost of $455,000 per fracture prevented[7]
- number need to treat to prevent one vertebral fracture is 30[8]
Radiology
- DEXA before & during teriparatide not useful for assessing response to therapy or revision of fracture risk[4]
More general terms
References
- ↑ Prescriber's Letter 10(1):5 2003
- ↑ 2.0 2.1 Bauer DC Review: human parathyroid hormone reduces fractures and increases bone mineral density in severe osteoporosis. ACP J Club. 2006 Nov-Dec;145(3):71. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17080983
- ↑ Cranney A et al Parathyroid hormone for the treatment of osteoporosis: a systematic review. CMAJ. 2006 Jul 4;175(1):52-9. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16818910
- ↑ 4.0 4.1 4.2 Medical Knowledge Self Assessment Program (MKSAP) 19 American College of Physicians, Philadelphia 2022
- ↑ 5.0 5.1 Young K, Fairchild DG, Di Francesco L Experimental Drug Abaloparatide Tied to Reduced Fracture Risk in Osteoporosis. Physician's First Watch, Aug 17, 2016 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
- ↑ 6.0 6.1 Geriatric Review Syllabus, 10th edition (GRS10) Harper GM, Lyons WL, Potter JF (eds) American Geriatrics Society, 2019
- ↑ 7.0 7.1 Albert SG, Reddy S CLINICAL EVALUATION OF COST EFFICACY OF DRUGS FOR TREATMENT OF OSTEOPOROSIS: A META-ANALYSIS. Endocr Pract. 2017 Jul;23(7):841-856 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28448754
- ↑ 8.0 8.1 Reginster JY, Hattersley G, Williams GC et al Abaloparatide is an Effective Treatment Option for Postmenopausal Osteoporosis: Review of the Number Needed to Treat Compared with Teriparatide. Calcif Tissue Int. 2018 Nov;103(5):540-545. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29951742 Free PMC article