II. Mechanism

  1. Recombinant Parathyroid Hormone
  2. Significant bone anabolic activity

III. Indications: Severe Osteoporosis

  1. Women, postmenopausal, with severe bone loss
  2. Men with Osteoporosis and high risk of Fracture
  3. Osteoporosis refractory to Bisphosphonates

IV. 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]

V. 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]

VII. Adverse Effects

VIII. 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)

IX. Resources

Images: Related links to external sites (from Bing)

Related Studies

Cost: Medications

teriparatide (on 11/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TERIPARATIDE 620 MCG/2.48 ML Generic $996.60 per ml
forteo (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
FORTEO 600 MCG/2.4 ML PEN INJ $1,596.70 per ml
tymlos (on 1/1/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TYMLOS 80 MCG DOSE PEN INJECTR $1,413.23 per ml