From the Guidelines
Forteo (teriparatide) should be paused before hip replacement surgery to minimize potential interference with bone healing and surgical outcomes. The decision to pause Forteo is based on its mechanism of action, which stimulates bone formation through parathyroid hormone activity, increasing bone turnover and remodeling 1. This increased bone turnover could theoretically affect the stability of implants and the quality of new bone formation around the prosthesis. Additionally, Forteo alters calcium metabolism, and surgeons prefer to avoid potential complications related to calcium regulation during the perioperative period.
Key Considerations
- The exact timing for stopping Forteo is not specified in the provided guidelines, but typically, doctors recommend stopping it 1-2 weeks before elective orthopedic surgery like hip replacement.
- After surgery, most physicians recommend waiting until initial healing has occurred, typically 4-6 weeks, before resuming Forteo therapy.
- The provided guidelines focus on the perioperative management of antirheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty, but do not specifically address Forteo 1.
- However, considering the potential risks and benefits, it is recommended to pause Forteo before hip replacement surgery and restart it after initial healing has occurred, under the guidance of an orthopedic surgeon and the physician who prescribed the medication.
Recommendations
- Pause Forteo 1-2 weeks before hip replacement surgery to minimize potential interference with bone healing and surgical outcomes.
- Restart Forteo after initial healing has occurred, typically 4-6 weeks after surgery, under the guidance of an orthopedic surgeon and the physician who prescribed the medication.
- Individual circumstances may vary based on specific bone health needs and surgical plan, and the decision to pause and restart Forteo should be made on a case-by-case basis.
From the Research
Reasons to Pause Forteo Before Hip Replacement Surgery
- The use of bisphosphonates, which are related to Forteo in the treatment of osteoporosis, preoperatively is associated with higher rates of intraoperative and 1-year postoperative complications in total hip arthroplasty (THA) patients, including periprosthetic fractures and revisions 2.
- Teriparatide, the active ingredient in Forteo, has been shown to increase bone mineral density and reduce the risk of fractures, but its use before hip replacement surgery may not be necessary and could potentially increase the risk of complications 3, 4.
- A systematic review and meta-analysis found that teriparatide showed better performance over bisphosphonates in BMD enhancement, bone fracture reduction, and bone remodeling improvement, without increasing the incidence of adverse effects 4.
- Another study found that teriparatide exhibited better fusion rates and reduced complications than controls and bisphosphonates in patients with poor bone quality scheduled for posterior spine fusion, resulting in improved patient-reported outcomes 5.
- A network meta-analysis found that bisphosphonates and denosumab may be effective anti-osteoporotic drugs for preventing periprosthetic proximal femoral bone loss after total hip arthroplasty, but the efficacy of teriparatide was not clearly established 6.
Potential Risks of Continuing Forteo Before Hip Replacement Surgery
- Increased risk of periprosthetic fractures and revisions 2
- Potential for increased bone loss and decreased bone density around the prosthetic implant 6
- Uncertain efficacy of teriparatide in preventing periprosthetic bone loss after total hip arthroplasty 6