Teriparatide (recombinant human parathyroid hormone [1–34]) is an anabolic agent approved for the treatment of patients at high risk for fracture. The Fracture Prevention Trial administered teriparatide to treatment-naïve patients, leading to its US Food and Drug Administration approval in 2002. Clinical trial data using antiresorptive agents administered before, during, and after any parathyroid hormone (PTH) therapy, as well as alternative PTH dosing, have provided additional insight yet raise fundamental questions about the most appropriate use of teriparatide. This article provides an update on teriparatide, focusing on its mechanism of action compared with other antiresorptive agents, indications, adverse effects, therapy duration, combination therapy, contraindications, and cost effectiveness.
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References and Recommended Reading
Neer RM, Arnaud CD, Zanchetta JR, et al.: Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001, 344:1434–1441.
Prevrhal S, Krege JH, Chen P, et al.: Teriparatide vertebral fracture risk reduction determined by quantitative and qualitative radiographic assessment. Curr Med Res Opin 2009, 25:921–928.
Saag KG, Shane E, Boonen S, et al.: Teriparatide or alendronate in glucocorticoid-induced osteoporosis. N Engl J Med 2007, 357:2028–2039.
McClung MR, San Martin J, Miller PD, et al.: Opposite bone remodeling effects of teriparatide and alendronate in increasing bone mass. Arch Intern Med 2005, 165:1762–1768.
Keaveny TM, Donley DW, Hoffmann PF, et al.: Effects of teriparatide and alendronate on vertebral strength as assessed by finite element modeling of QCT scans in women with osteoporosis. J Bone Miner Res 2007, 22:149–157.
Keaveny TM, Hoffmann PF, Mitlak BH, et al.: Comparison of the effects of teriparatide and alendronate on parameters of total hip strength as assessed by finite element analysis: results from the forteo and alendronate comparator trial. J Bone Miner Res 2007, 22(Suppl 1):S26.
Kanis JA, Johnell O, Oden A, et al.: FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008, 19:385–397.
Tosteson AN, Melton LJ 3rd, Dawson-Hughes B, et al.: Cost-effective osteoporosis treatment thresholds: the United States perspective. Osteoporos Int 2008, 19:437–447.
Vahle JL, Sato M, Long GG, et al.: Skeletal changes in rats given daily subcutaneous injections of recombinant human parathyroid hormone (1–34) for 2 years and relevance to human safety. Toxicol Pathol 2002, 30:312–321.
Vahle JL, Long GG, Sandusky G, et al.: Bone neoplasms in F344 rats given teriparatide [rhPTH(1–34)] are dependent on duration of treatment and dose. Toxicol Pathol 2004, 32, 426–438.
Tashjian AH Jr, Chabner BA: Commentary on clinical safety of recombinant human parathyroid hormone 1–34 in the treatment of osteoporosis in men and postmenopausal women. J Bone Miner Res 2002, 17:1151–1161.
Harper KD, Krege JH, Marcus R, Mitlak BH: Osteosarcoma and teriparatide? J Bone Miner Res 2007, 22:334.
Lindsay R, Scheele WH, Neer R, et al.: Sustained vertebral fracture risk reduction after withdrawal of teriparatide in postmenopausal women with osteoporosis. Arch Intern Med 2004, 164:2024–2030.
Black DM, Bilezikian JP, Ensrud KE, et al.: One year of alendronate after one year of parathyroid hormone (1–84) for osteoporosis. N Engl J Med 2005, 353:555–565.
McClung MR: Do current management strategies and guidelines adequately address fracture risk? Bone 2006, 38(2 Suppl 2):S13–S17.
Black DM, Greenspan SL, Ensrud KE, et al.: The effects of parathyroid hormone and alendronate alone or in combination in postmenopausal osteoporosis. N Engl J Med 2003, 349:1207–1215.
Gasser JA, Ingold P, Venturiere A, Green JR: Chronic subcutaneous, but not single intravenous dosing of rats with bisphosponates resuts in reduced bone anabolic response to PTH. J Bone Miner Res 2006, 21(Suppl 1):S113.
Kostenuik PJ, Capparelli C, Morony S, et al.: OPG and PTH-(1–34) have additive effects on bone density and mechanical strength in osteopenic ovariectomized rats. Endocrinology 2001, 142:4295–4304.
Cummings SR, McClung MR, Christiansen C, et al.: A phase III study of the effects of denosumab on vertebral, nonvertebral, and hip fracture in women with osteoporosis: results from the FREEDOM Trial. J Bone Miner Res 2008, 23:S80.
Lindsay R, Nieves J, Formica C, et al.: Randomised controlled study of effect of parathyroid hormone on vertebral-bone mass and fracture incidence among postmenopausal women on oestrogen with osteoporosis. Lancet 1997, 350:550–555.
Deal C, Omizo M, Schwartz EN, et al.: Combination teriparatide and raloxifene therapy for postmenopausal osteoporosis: results from a 6-month double-blind placebo-controlled trial. J Bone Miner Res 2005, 20:1905–1911.
Ettinger B, San Martin J, Crans G, Pavo I: Differential effects of teriparatide on BMD after treatment with raloxifene or alendronate. J Bone Miner Res 2004, 19:745–751.
Russell RG, Xia Z, Dunford JE, et al.: Bisphosphonates: an update on mechanisms of action and how these relate to clinical efficacy. Ann NY Acad Sci 2007, 1117:209–257.
Miller PD, Delmas PD, Lindsay R, et al.: Early responsiveness of women with osteoporosis to teriparatide after therapy with alendronate or risedronate. J Clin Endocrinol Metab 2008, 93:3785–3793.
Eastell R, Nickelsen T, Marin F, et al.: Sequential treatment of severe postmenopausal osteoporosis following teriparatide: Final results of the randomized, controlled European study of Forsteo (EUROFORS). J Bone Miner Res 2009, 24:726–736.
Cosman F, Nieves J, Zion M, et al.: Daily and cyclic parathyroid hormone in women receiving alendronate. N Engl J Med 2005, 353:566–575.
Cosman F, Wermers RA, Recknor C, et al.: Efficacy of adding teriparatide versus switching to teriparatide in postmenopausal women with osteoporosis previously treated with raloxifene or alendronate. J Bone Miner Res 2007, 22(Suppl 1):S127.
Hodsman AB, Fraher LJ, Watson PH, et al.: A randomized controlled trial to compare the efficacy of cyclical parathyroid hormone versus cyclical parathyroid hormone and sequential calcitonin to improve bone mass in postmenopausal women with osteoporosis. J Clin Endocrinol Metab 1997, 82:620–628.
Saag KG, Zanchetta JR, Devogelaer JP, et al.: Teriparatide versus alendronate for treatment of glucocorticoid-induced osteoporosis: 36-month results. J Bone Miner Res 2008, 23(Suppl 1):S49.
Holick MF, Chen TC: Vitamin D deficiency: a worldwide problem with health consequences. Am J Clin Nutr 2008, 87:1080S–1086S.
File EA, Deal CL: BMD response to teriparatide in patients previously treated with bisphosphonate versus treatment naive patients. Arthritis Rheum 2007, 56:S266.
Chen P, Satterwhite JH, Licata AA, et al.: Early changes in biochemical markers of bone formation predict BMD response to teriparatide in postmenopausal women with osteoporosis. J Bone Miner Res 2005, 20:962–970.
Jemal A, Siegal R, Ward E, et al.: Cancer statistics, 2006. CA Cancer J Clin 2006, 56:106–130.
Coleman RE, Rubens RD: The clinical course of bone metastases from breast cancer. Br J Cancer 1987, 55:61–66.
Oka H, Kondoh T, Seichi A, et al.: Incidence and prognostic factors of Japanese breast cancer patients with bone metastasis. J Orthop Sci 2006, 11:13–19.
Andreassen TT, Ejersted C, Oxlund H: Intermittent parathyroid hormone (1–34) treatment increases callus formation and mechanical strength of healing rat fractures. J Bone Miner Res 1999, 14:960–968.
Nakajima A, Shimoji N, Shiomi K et al.: Mechanisms for the enhancement of fracture healing in rats treated with intermittent low-dose human parathyroid hormone (1–34). J Bone Miner Res 2002, 17:2038–2047.
Whyte MP, Mumm S, Deal C: Adult hypophosphatasia treated with teriparatide. J Clin Endocrinol Metab 2007, 92:1203–1208.
Lundkvist J, Johnell O, Cooper C, Sykes D: Economic evaluation of parathyroid hormone (PTH) in the treatment of osteoporosis in postmenopausal women. Osteoporos Int 2006, 17:201–211.
Liu H, Michaud K, Nayak S, et al.: The cost-effectiveness of therapy with teriparatide and alendronate in women with severe osteoporosis. Arch Intern Med 2006, 166:1209–1217.
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File, E., Deal, C. Clinical update on teriparatide. Curr Rheumatol Rep 11, 169–176 (2009). https://doi.org/10.1007/s11926-009-0023-3
- Bone Mineral Density
- Vertebral Fracture
- Zoledronic Acid