Parathyroid hormone for osteoporosis

Examples

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Brand Name	Generic Name
Forteo	teriparatide

Teriparatide (Forteo) has been approved by the U.S. Food and Drug Administration (FDA) to treat osteoporosis in men and women. It is given by daily injection.

How It Works

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Teriparatide is a synthetic version of parathyroid hormone, which is the body's primary regulator of calcium and phosphate in the bones. Teriparatide stimulates bone growth and slows the rate of bone loss.¹

Why It Is Used

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Teriparatide is used to treat severe osteoporosis in people at high risk for bone fractures. It can be used by both men and women. Teriparatide is a relatively new osteoporosis medication, and its long-term effects are unknown. Teriparatide treatment is reserved for people with severe osteoporosis who are unable to take other medications, or for whom other medications are not effective. The reasons why teriparatide is used after other treatments include its high cost, need for daily injections, and unknown long-term effects.

How Well It Works

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Studies show that taking teriparatide along with supplemental calcium and vitamin D significantly increased bone density at the spine and hip, compared to taking only calcium and vitamin D. Also, parathyroid hormone reduced the risk of fractures in postmenopausal women.² The risk of fractures was not studied in men.³

Teriparatide should not be taken at the same time with bisphosphonates. Taking these medicines together does not build more bone density.^{4 5} But taking the two medications at different times and in a specific order may build more bone density. For example, you could take teriparatide for one year and then take a bisphosphonate for the following year to maintain or build bone density.⁶

Side Effects

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The most common side effects are:

• Nausea and vomiting.
• Leg cramps.
• Headache.
• Dizziness.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

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Teriparatide is very expensive and must be given by daily injections.

In animal studies of teriparatide, some rats developed a form of bone cancer called osteosarcoma. So far in human studies of teriparatide, no cases of osteosarcoma have been reported; however, these studies have lasted only a few years, so the risk is still unknown. Until long-term effects are known, it is not recommended that teriparatide be taken for longer than 2 years. After you quit taking teriparatide, you will take another medicine such as alendronate, which is a bisphosphonate, to prevent bone loss.

Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.

References

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Citations

1. Neer RM, et al. (2001). Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. New England Journal of Medicine, 344(19): 1434–1441.

2. Drugs for postmenopausal osteoporosis (2008). Treatment Guidelines From the Medical Letter, 6(74): 67–74.

3. Abramowicz M (2003). Teriparatide (Forteo) for osteoporosis. Medical Letter on Drugs and Therapeutics, 45(1149): 9–10.

4. Black DM, et al. (2003). The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. New England Journal of Medicine, 349(13): 1207–1215.

5. Finklestein JS, et al. (2003). The effects of parathyroid hormone, alendronate, or both in men with osteoporosis. New England Journal of Medicine, 349(13): 1216–1226.

6. Black DM, et al. (2005). One year of alendronate after one year of parathyroid hormone (1-84) for osteoporosis. New England Journal of Medicine, 353(6): 555–565.

Credits

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Author	Shannon Erstad, MBA/MPH
Editor	Kathleen M. Ariss, MS
Associate Editor	Pat Truman, MATC
Primary Medical Reviewer	Anne C. Poinier, MD - Internal Medicine
Specialist Medical Reviewer	Kirtly Jones, MD - Obstetrics and Gynecology
Last Updated	November 21, 2008