Definitive studies have shown that a genetically engineered form of human parathyroid hormone (PTH [I-34]) stimulates new bone formation and increased bone mineral density (BMD) in osteoporotic patients. Unlike current medications available for the treatment of Osteoporosis, which act by inhibiting the breakdown of bone by osteoclast cells, PTH is an anabolic agent that directly stimulates bone growth. A first in treating osteoporosis, PTH directly builds bone. This new agent, Forteo is produced by the Eli Lilly Company and is considered a “natural” hormone. Forteo is approved by the US Food and Drug Administration (FDA) for the treatment of osteoporosis in men and postmenopausal women who are at high risk for fracture.
Potential candidates for PTH including postmenopausal women or men with primary or hypogonadal osteoporosis who have greater than one of the following characteristics:
- History of osteoporotic fracture
- Failed or intolerant to current treatment
- Multiple risk factors:
- T-score < -3.0
- Maternal history of hip fracture
- Sedentary lifestyle
- Low lifelong calcium intake
- Smoking habit
- Glucocorticoid use
PTH is injected into the thigh or abdominal wall, subcutaneous (under the skin). These injections come preloaded with 28 doses in a special syringe, which must be refrigerated. This drug, which is given once daily, is reserved for treating patients with severe or advanced osteoporosis, as opposed to treating the broader population of osteoporotic patients. Currently, PTH is approved for up to 24 months of therapy. The cost of Forteo is currently 10 times greater than other agents for osteoporosis.
Possible Side Effects:
- Typically mild: Nausea, dizziness, leg cramps
- “Black Box” warning: increase risk of osteosarcoma in rats.
- Paget’s disease
- Received radiation therapy
- Other metabolic bone diseases
- Hypercalcemic disorders (i.e. primary hyperparathyroidism)
- Greater 2 yrs treatment not recommended
Although PTH presents answers to treating problem patients with osteoporosis, some questions remain. Its optimal use in combination with other agents (such as Fosamax or Actonel) needs to be explored. Current recommendations suggest that only specialists in the treatment of osteoporosis can prescribe PTH. These physicians include Endocrinologists. Please consult your primary care physician for further information.
Please note that this article reflects current medical understanding. As new information becomes available some of these findings may change. Please note this synopsis is intended for educational purposes and cannot replace a medical evaluation.
13710 Olive Boulevard (Primary Office)
Chesterfield, MO 63017
Telephone: 314-469-PAIN (7246)
Exchange: 314-441-6965 (for after-hour Emergencies Only)
Monday thru Friday
8:30 AM – 4:30 PM