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