Human recombinant parathyroid hormone that stimulates bone formation by stimulating osteoblasts and accelerates bone remodeling.
Approved for use for up to two years, as it can cause osteosarcoma in rat models.
Contraindicated in patients with increased risk for osteosarcoma, including Paget’s diseae of bone or previous external beam or implant radiation involving the skeleton.
Contraindicated in patients with unexplained high alkaline phosphatase levels.
Bone density increases when patients who have been taking bisphosphonates are switched to this agent.
Administered subcutaneously.
Compared to placebo use of this drug improves outcome in patients with chronic periodontitis following peridontal surgery demonstrtating greater resolution of alveolar bone defects, and accelerated osseous wound healing in the oral cavity (Bashutski JD et al).
Teriparatide a recombinant human parathyroid 1-34 is utilized for treatment of glucocorticoid induced osteoporosis.
In a 18 month randomized trial comparing teriparatide with alendronate in patients with glucocorticoid induced osteoporosis, teriparatide increased spinal bone mineral density over a shorter period and to a greater extent than did alendronate and also reduced vertebral fractures by 90% (Saag KG et al).
This agent also decreases nonvertebral fractures by 50% but has not been shown to specifically decrease hip fractures.
Tetiparatide reduces the risk of vertebral fracture compared to with bisphosphonates.
Daily subcutaneous administration prevents glucocorticoid induced increase in osteoblast and osteocyte apoptosis and decrease in the osteoblast number, bone formation and bone strength.
Terparatide efficacy is compromised by high dose glucocorticoid therapy.
Teriparatide is administered subcutaneously for up to 2 years.
It is contraindicated in patients with hyperparathyroidism because they may exacerbate hypercalcemia, and an individuals with skeletal malignancy or conditions that have increased osteosarcoma risk, such as prior skeletal radiation or page disease of bone:post marketing surveillance studies have shown no excess osteosarcoma risk in people taking this drug.
Side effects include transient hypotension with the first dose of terraparatide, nausea, dizziness, palpitations, headache, myalgia, and hypercalcemia.
Loss of bone mass occurs after discontinuation so the use of an anti-resorptive therapy such as bisphosphonates or denosumab should be prescribed after discontinuation of analogs of human parathyroid hormone.
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