From the Guidelines
The recommended daily dose of teriparatide is 20 micrograms (mcg) administered once daily as a subcutaneous injection. This dose has been shown to be effective in reducing the risk of vertebral and non-vertebral fractures in patients with postmenopausal osteoporosis, as demonstrated in a study by Harvey et al 1. The study found that teriparatide significantly reduced the risk for nonvertebral and morphometric vertebral fractures by a statistically significant 66 % decrease.
Administration and Storage
Teriparatide comes in a prefilled pen device containing 28 doses, which should be stored in the refrigerator but can be at room temperature during use 1. The injection should be given at approximately the same time each day to maintain consistent blood levels.
Treatment Duration and Safety
Treatment duration is typically limited to 24 months total lifetime exposure due to safety concerns, such as the potential increased risk for osteosarcoma 1. Patients should also take calcium and vitamin D supplements during treatment unless contraindicated.
Efficacy and Side Effects
Teriparatide works by directly stimulating osteoblasts to build new bone, making it effective for severe osteoporosis 1. It's particularly useful for patients with very low bone density, those who have experienced fractures despite other osteoporosis treatments, or those who cannot tolerate or have failed other therapies. Common side effects include dizziness, leg cramps, and mild injection site reactions.
Key Considerations
- Patients with a history of malignancy prone to metastasize to bone should avoid teriparatide due to the theoretical risk of propagating microscopic bone metastases 1.
- In cases of severe osteoporosis with fractures occurring on bisphosphonate therapy, the benefits of teriparatide may outweigh the theoretical risks 1.
From the FDA Drug Label
DOSAGE AND ADMINISTRATION Recommended dosage is 20 mcg subcutaneously once a day (2. 1) The daily dose of teriparatide is 20 mcg administered subcutaneously once a day 2.
From the Research
Teriparatide Daily Dose
- The recommended daily dose of teriparatide is 20 μg given subcutaneously 3, 4, 5, 6, 7
- This dose is established for the treatment of postmenopausal osteoporosis (PMO) 3
- Studies have shown that teriparatide at this dose increases bone mineral density (BMD) and reduces fracture risk 4, 6, 7
- The daily dose of 20 μg has been compared to other doses, such as 40 μg, and has been shown to be effective in increasing BMD and reducing fracture risk 6
- The efficacy of teriparatide at this dose has been assessed in various patient populations, including Japanese patients with osteoporosis 7
Administration and Safety
- Teriparatide is administered subcutaneously, typically on a daily basis 3, 4, 5, 6, 7
- The safety of teriparatide at the recommended daily dose has been evaluated in several studies, with common adverse effects including nausea, headache, and hypercalcemia 5, 6
- The need for daily subcutaneous injections and refrigeration of prefilled syringes are notable disadvantages of teriparatide therapy 6
Efficacy in Different Patient Populations
- Teriparatide has been shown to be effective in increasing BMD and reducing fracture risk in various patient populations, including postmenopausal women with osteoporosis 3, 4, 6, 7
- The efficacy of teriparatide has also been assessed in institutionalized individuals with osteoporosis, with results showing increased BMD and reduced fracture risk 5
- The baseline status of serum bone turnover markers and vitamin D levels does not appear to affect the efficacy of teriparatide 7