Osteoporosis teriparatide

Teriparatide, the recombinant form of PTH 1-34, is approved for treatment of osteoporosis. Teriparatide is given in a dosage of 20 meg subcutaneously daily. Like fluoride, teriparatide stimulates new bone formation, but unlike fluoride, this new bone appears structurally normal and is associated with a substantial reduction in the incidence of fractures. Teriparatide is approved for use for only 2 years. Trials examining the sequential use of teriparatide followed by a bisphosphonate after 1 or 2 years are in progress and look promising. Giving teriparatide with a bisphosphonate has not shown greater efficacy than the bisphosphonate alone. 

Clinical Effectiveness. Teriparatide works equally well in women and men with osteoporosis. Teriparatide has reduced the risk of new vertebral fractnres by 65% compared with placebo (actnal fracture incidence 5% vs. 14%, respectively) in postmenopausal women with osteoporosis and pre-existing fractures. New nonvertebral fracture risk was reduced by 53% (3% fractures with teriparatide vs. 6% fractures with placebo) with the 20-mcg/day dosage. Teriparatide can... 

In postmenopausal women with osteoporosis, teriparatide increases bone mineral density and reduces the risk of vertebral and nonvertebral fractures. The precise role of this agent relative to other agents used for osteoporosis, alone or in combination, remains to be determined. Candidates for teriparatide therapy at this time are women with a history of an osteoporotic fracture who have multiple risk factors for fracture and who are intolerant or have failed other therapies. The drug is also approved to increase bone mass in men with idiopathic or hypogonadal osteoporosis who are at high risk for fracture. 

Compared with postmenopausal osteoporosis, few clinical trials have been conducted evaluating therapies in men. Although alendronate and calcitonin have both been studied, only alendronate reduces fracture rates in men. Teriparatide also has been studied, but no data are available yet on fracture rates. At this time, alendronate and teriparatide are approved by the FDA for the treatment of osteoporosis in men. Owing to proven benefit in reducing fractures and relative safety, alendronate should be considered first-line treatment for primary osteoporosis in men. Teriparatide should be reserved as alternate therapy in this population. 

Deal C, Omizo M, Schwartz EN, Eriksen EF, Cantor P, Wang J, et al. (2004) Raloxifene in combination with teriparatide reduces teriparatide-induced stimulation of bone resorption but not formation in postmenopausal women with osteoporosis. J Bone Min Res 19(Suppl 1) 1169... 

Teriparatide (Forteo) [Antiosteoporotic/Parathyroid Hormono] WARNING T Osteosarcoma risk in animals, therefore only use in pts for whom the potential benefits outweigh risks Uses Severe/refractory osteoporosis Action PTH (recombinant) Dose 20 meg SQ daily in thigh or abd Caution [C, /-] Contra w/ Paget Dz, prior radiation, bone metastases, T Ca caution in urolithiasis Disp Inj SE Orthostatic X BP on administration, N/D, T... 

Teriparatide is a recombinant form of parathyroid hormone, used in the treatment of advanced osteoporosis. 

Calcitonin is approved for use in the treatment of postmenopausal osteoporosis. It has been shown to increase bone mass and reduce fractures, but only in the spine. It does not appear to be as effective as bisphosphonates or teriparatide. 

Teriparatide These hormones act on their cognate receptors coupled to G protein signaling pathways Teriparatide stimulates bone turnover, calcitonin suppresses bone resorption Both are used in osteoporosis calcitonin is used for hypercalcemia Teriparatide may cause hypercalcemia and hypercalciuria... 

Body JJ, Gaich GA, Scheele WH, Kulkarni PM, Miller PD, Peretz A, Dore RK, Correa-Rotter R, Papaioannou A, Cumming DC, Hodsman AB. A randomized double-blind trial to compare the efficacy of teriparatide [recombinant human parathyroid hormone (1-34)] with alendronate in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 2002 87(10) 4528-35. 

Teriparatide, the N-terminal 34-mer of full-length PTH, is currently approved for the treatment of men or post-menopausal women who are at a high risk for fracture. Teriparatide is the only approved anabolic treatment for osteoporosis other drugs for osteoporosis primarily affect bone resorption [46, 47]. Teriparatide... 

Fig. 12.3 Effects of daily teriparatide (TPTD) administration on biomarkers of bone formation (bone ALP and PICP) and bone resorption (DPD/Cr and NTx/Cr) in postmenopausal women with osteoporosis. Changes in bone formation markers at 1 month were significantly correlated with improvements in bone structure after 22 months of treatment (from [48]). 

Hodsman AB, Bauer DC, Dempster DW, Dian L, Hanley DA, Harris ST, Kendler DL, McClung MR, Miller PD, Olszynski WP, Orwoll E, Yuen CK. Parathyroid hormone and teriparatide for the treatment of osteoporosis a review of the evidence and suggested guidelines for its use. Endocrine Rev 2005 26 688-703. 

Options for treatment include hormone replacement therapy (HRT), bisphosphonates, calcitriol, calcitonin, raloxifene, strontium ranelate, and teriparatide. Hormone replacement therapy is generally indicated for women who are under 50 years and are experiencing a premature menopause. Symptomatic menopausal women may opt to use HRT also, as the benefits outweigh the risks for up to 5 years treatment. They may choose an alternative treatment for osteoporosis if preferred. Hormone replacement therapy is not recommended for first line treatment for long-term prevention of osteoporosis in women over 50 years of age. 

Teriparatide is a recombinant human parathyroid hormone which promotes bone growth. It is available in the form of an injection and only prescribed by osteoporosis specialists. NICE have issued guidance on who is eligible to receive it. 

National Institute for Health and Clinical Excellence (2008) NICE Technology appraisal 161, Osteoporosis - secondary prevention, including strontium ranelate. Alendronate, etidronate, risedronate, raloxifene, strontium ranelate and teriparatide for secondary prevention of osteoporotic fractures in post menopausal women. Available at http //www.nice.org.uk/Guidance/TA161 [Accessed 18 November 2008],... 

The polypeptide parathormone is released from the parathyroid glands when the plasma Ca2+ level falls. It stimulates osteoclasts to increase bone resorption in the kidneys it promotes calcium reabsorption, while phosphate excretion is enhanced. As blood phosphate concentration diminishes, the tendency of Ca2+ to precipitate as bone mineral decreases. By stimulating the formation of vitamin D hormone, parathormone has an indirect effect on the enteral uptake of Ca2+ and phosphate. In parathormone deficiency, vitamin D can be used as a substitute that, unlike parathormone, is effective orally. Teriparatide is a recombinant shortened parathormone derivative containing the portion required for binding to the receptor. It can be used in the therapy of postmenopausal osteoporosis and promotes bone formation. While this effect seems paradoxical in comparison with hyperparathyroidism, it obviously arises from the special mode of administration the once daily s.c. injection generates a quasi-pulsatile stimulation. Additionally, adequate intake of calcium and vitamin D must be ensured. 

Teriparatide (a recombinant PTH, residues 1 -34), which has been shown to be effective in osteoporosis. It acts like PTH and stimulates osteoblasts. It is used mostly for patients with established osteoporosis (who have already fractured), who have particularly low BMD or several risk factors for fracture, or who cannot tolerate the oral bisphosphonates. 

Forteo Teriparatide [human parathyroid hormone (1-34)] 6 Eli Lilly Osteoporosis >2000... 

Teriparatide Forteo (Lilly) Osteoporosis with fracture risk Bone mass increase in hypogonadal men... 

Drugs currently used to treat osteoporosis are classified into those that inhibit osteoclastic bone resorption (including bisphos-phonates, denosumab, and selective estrogen receptor modulators) and those that stimulate bone formation by osteoblasts (parathyroid hormone and derivatives, such as teriparatide). Strontium ranelate may have a dual effect. Other drugs being tested in clinical trials include inhibitors of cathepsin K (an osteoclastic enzyme critical for bone resorption) and of sclerostin (a negative modulator of the Wnt pathway) [21],... 

Teriparatide contains the first 34 amino acids in human parathyroid hormone and represents a novel approach to osteoporosis treatment. Although hyperparathyroidism leads to bone loss (see Fig. 88-3), therapeutic doses (for shorter periods of time) conversely improve BMD and rednce fractnre risk. Parathyroid hormone is currently the only approved osteoporosis medication that works by stimulating bone formation. Becanse of adverse effects and cost concerns, teriparatide is reserved for treating those at high risk of osteoporosis-related fracture who cannot or will not take or have failed bisphosphonate therapy. 

Teriparatide is commercially available as a prefiUed 3-mL pen-type delivery device that administers subcutaneous injections in the thigh or abdominal area (see Table 88-6). The initial dose should be administered with the patient either sitting or lying down in case orthostatic hypotension occurs. Health care providers should re-educate patients about syringe use with each refill, and the patient or caregiver should also re-read the user s manual each month. The pen should be refrigerated and can be used for up to 28 days following the initial injection. Teriparatide is also the most expensive of the approved osteoporosis therapies. 

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