Forteo
February 21, 2011 8 CommentsForteo (Teriparatide) is the only Anabolic osteoporosis medication in the USA. It acts by directly stimulating the Osteoblast cells that make new bone matrix. It is the only type of osteoporosis medication which actually grows substantial new bone. See my post about “Osteoclasts Gone Wild”.
Forteo is a daily shot with a tiny needle that I cannot see without my glasses. Maximum time on Forteo is 2 years. Most osteoporosis doctors follow 2 years of Forteo with 3 years of an Antiresorptive medication. That preserves the new bone matrix while waiting for all of the calcium to be deposited in the new bone. Total increase in bone matrix and in Bone Mineral Density averages 30 to 35 percent.
Possible side effects include dizziness if you stand up immediately after taking your shot. This and other problems, including aches and pains, happened at the about same rate in patients who were given Forteo or given a placebo (fake) shot during testing.
Although humans have not had an increase in bone cancer while on Forteo, laboratory rats did, when they were given much higher doses of the same drug, and for the equivalent of 70 human years. We do not give Forteo to persons who have: bones that are still growing, Paget’s disease, other cancers which have spread to bone, or high dose radiation to bone. No increase in the rate of bone cancers has been found in over 500,000 humans taking Forteo.
Forteo is often my first choice in patients who already have fractures. Those can be fractures which they knew about, or spine fractures that we detect with VFA. Forteo is the only medicine which stimulates substantial new bone matrix formation. Forteo is often the best choice when the bones have proven that they are not “good enough” by Fragility Fracture. As an orthopedic surgeon, my view of osteoporosis treatment is all about fracture prevention.
Jay Ginther, MD
2008 / Revised Feb 2011
Tags
anabolicBMDBone DensityBone MatrixBone TurnoverForteoFractureFragility FractureOsteoblastsOsteoporosisOsteoporosis medicationSpine FractureTeriparatideVertebral FractureVFACategorised in: Medications, Osteoporosis
Diane Bjork
I have been on Reclast for going on four years now. Six months ago I had a stress fracture in my 2nd metatarsal, left foot. I was in a walking boot for 2 1/2 months. I was released from the boot. Having pain on side of my right foot now and again on the left. Diagnosed with a now complete fracture of the 2nd metatarsal that has not healed properly. Wondering if I should try something other than Reclast for the osteoporosis. Thank you.
Dr Ginther
Forteo is the med of choice to heal a stress fracture
All osteoporosis medications could slow healing of a stress fracture, or at least not help
L P
My last DEXA showed a negatibe t. score of -3.4 in my lumbar spine. I was on Fosomax for about 10 years and stopped in October of 2011 which is one year & 2 months now without any meds – still trying to figure our my next medication. What do you recommend pill wise because I am afraid of Forteo due to bone cancer. Please advise. Lili
Dr. Ginther
I am deleting your identifying info before I approve your question
-3.4 is low. If you also have vertebral deformities on your VFA or a history of other fractures, you have “severe osteoporosis”. I would need the results of a complete eval in order to make an actual recommendation, but several points are relevant.
10 years of Fosamax should have maxed out the benefit of Bisphosphonates.
The only non-bisphosphonate pill is Evista
Prolia is also not a bisphosphonate, and might be a good option if you need to resume an anti-resorptive.
If you have been loosing BMD while on Fosamax, your best bet could be Forteo. We have no evidence that it will cause osteosarcoma in humans. JBMR published a study this month that I will be summarizing soon. Watch for it.
Jay Ginther, MD
Linda
I am a 56 year old female in good health with no past history of any major diseases or broken bones. My dexa score in my hip just came back at -3.1 and my spine -1.3. My physician want to put me on Forteo which concerns me as my father had bone cancer when he was 65. Is this something that could be addressed through change of diet and an excersize program or is medication inevitable. What do you think??
Dr. Ginther
Several comments.
Many relavent blogs on the site already.
The spine t-score likely indicates increased density from arthritis, disc disease or other issues. See if you can have the DXA reread by someone following ISCD guidelines.
You should get a lateral spine or VFA to add to the mix, as well as the full lab work-up.
Only if you have been seriously neglecting Calcium, Vitamin D3, and standing-walking exercises, are these alone likely to make much difference
Statistically your father (>50 to 1) probably had cancer which spread to bone rather than cancer starting in bone.
We have not seen increased Osteosarcoma (naturally occurs in 1 of every 250,000 adults) in humans. Most of the rats on the placebo also got Osteosarcoma because they do.
You need to thoroughly discuss your concerns with your doc.
Elaine
My question is will my parathyroid abilities maintain their role once the daily Forteo shots start? Is there damage to the parathyroid over the two years and does it recoup once the treatment is discontinued? With Thanks
Dr. Ginther
Parathyroid function is maintained during Forteo use as the Teriparatide remains detectable in the blood only a few hours. I am not aware of any reports of parathyroid damage by Forteo.
PTH level should be confirmed as normal before ANY osteoporosis med is started. Of course, 25-hydroxy Vit D and Calcium intake must be normalized before ANY med is started. See other blogs for these levels.
Remember, this is general advice, not specific to any individual without a full evaluation of that individual.