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Teriparatide Can Increase Bone Mass and Reduce Fractures in Patients With Osteoporosis

Teriparatide, a new bone-forming treatment, can significantly increase bone mass and reduce new fractures in patients with osteoporosis, according to recent studies.

Teriparatide, now available for patients with osteoporosis, can create bone tissue and increase bone mass. In this review, Dr H. Dobnig, Department of Internal Medicine, Medical University of Graz, Austria, reports on the efficacy and adverse effects of teriparatide, a recombinant formulation of parathyroid hormone.

Teriparatide consists of the first 34 amino acids of the N-terminal region of parathyroid hormone (PTH). In preclinical and clinical studies teriparatide has demonstrated it could increase trabecular and cortical bone mass and thus improve both bone microarchitecture and cortical bone thickness.

In a large randomised, double-blind placebo-controlled trial, researchers studied the rate of occurrence of new vertebral bone fractures in Caucasian women (median age 70 years) with osteoporosis. They observed a 65% reduction in new vertebral fractures when subcutaneous (SC) teriparatide 20 µg/day was administered to the participants.

The investigators noted a 90% reduction in moderate-to-severe vertebral fractures and a 77% decrease in multiple vertebral fractures in osteoporotic patients treated with teriparatide.

After 21 months of teriparatide therapy, the rate of occurrence of new nonvertebral fractures had decreased by 35%. The beneficial effect of the new bone-forming agent could already be observed after the first year of treatment, writes the author.

In another study, men with low bone mass were treated with teriparatide. Analysis showed a significant increase in bone mineral density in the men who received teriparatide compared to untreated postmenopausal women.

In a recent trial, results obtained in patients treated with teriparatide monotherapy were superior to those obtained in patients who received teriparatide-bisphosphonate combination. Researchers suggest that the anabolic capacity of teriparatide can be impaired if a bisphosphonate treatment is administered prior to teriparatide therapy.

Teriparatide monotherapy should be prescribed for a period ranging from 18 to 24 months. Medication capable of preventing bone resorption should be prescribed following teriparatide treatment in order to preserve the gain in bone mass obtained with the bone-forming drug.

Teriparatide treatment is well tolerated and no severe parathyroid hormone related adverse effect has been reported. Mild-to-moderate transient hypercalcaemia can be observed.

Teriparatide should only be prescribed to patients with the most severe forms of osteoporosis as the new treatment is very expensive. Only high-risk patients with a history of bone fracture should be offered the new medication, the author concludes.

Expert Opin Pharmacother 2004 May;5(5):1153-62

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