What is the treatment plan for a patient starting Forteo (teriparatide) for osteoporosis?

From the Guidelines

The treatment plan for a patient starting Forteo (teriparatide) involves daily subcutaneous injections of 20 mcg for up to 24 months, which is the maximum FDA-approved duration due to safety concerns, as recommended by recent guidelines 1.

Key Considerations

• Patients should administer the injection in the thigh or abdominal wall using the pre-filled pen device, rotating injection sites daily.
• Adequate calcium (1000-1200 mg daily) and vitamin D (800-1000 IU daily) supplementation should accompany Forteo therapy, as emphasized in the evidence-based guideline for the management of osteoporosis in men 1.
• Patients need baseline and periodic monitoring of serum calcium, as hypercalcemia can occur, and should be informed about potential side effects including dizziness, leg cramps, and nausea.

Treatment Approach

• Forteo works by stimulating new bone formation through its action as a parathyroid hormone analog, making it particularly effective for patients with severe osteoporosis or those who have failed other treatments, as noted in the American College of Physicians guideline update 1.
• After completing the Forteo course, patients should transition to an antiresorptive medication like a bisphosphonate to maintain bone density gains, in line with the recommendations for the management of osteoporosis in men 1.

Patient Education

• Patients should receive training on proper injection technique and be informed about the potential benefits and risks of Forteo therapy, including the risk of hypercalcemia and other adverse events, as highlighted in the evidence-based guidelines 1.

From the FDA Drug Label

DOSAGE AND ADMINISTRATION Recommended dosage is 20 mcg subcutaneously once a day (2. 1) Consider supplemental calcium and Vitamin D based on individual patient needs (2.1) Administer as a subcutaneous injection into the thigh or abdominal region (2.2) Administer initially under circumstances in which the patient can sit or lie down if symptoms of orthostatic hypotension occur (2. 2) Use of teriparatide for more than 2 years during a patient's lifetime should only be considered if a patient remains at or has returned to having a high risk for fracture (2.3)

The treatment plan for a patient starting Forteo (teriparatide) for osteoporosis is to administer 20 mcg subcutaneously once a day.

• The patient should be considered for supplemental calcium and Vitamin D based on individual needs.
• The injection should be administered into the thigh or abdominal region.
• The patient should be prepared to sit or lie down if symptoms of orthostatic hypotension occur.
• Treatment with teriparatide should not exceed 2 years, unless the patient remains at high risk for fracture 2.

From the Research

Treatment Plan for Forteo (Teriparatide)

The treatment plan for a patient starting Forteo (teriparatide) for osteoporosis typically involves:

• Subcutaneous administration of 20 microg/day of teriparatide 3
• Treatment duration of 11-21 months, with some studies suggesting treatment for up to 2 years 3, 4
• Monitoring of bone mineral density (BMD) and bone turnover markers, such as procollagen type 1 intact N-terminal propeptide (P1NP) and C-telopeptide (CTx) 5
• Regular measurement of serum calcium levels, particularly during the first three months of therapy 5

Patient Selection

Teriparatide is recommended for patients with:

• Severe osteoporosis, including postmenopausal women and men with idiopathic or hypogonadal osteoporosis 3, 4
• Glucocorticoid-induced osteoporosis, particularly those with a high risk of fracture 3, 6
• Low-turnover bone disease, such as in patients with chronic kidney disease (CKD) 7

Administration and Dosage

• Teriparatide should be administered subcutaneously, preferably in the morning before breakfast 6
• The recommended dosage is 20 microg/day, with some studies suggesting that the time of administration may affect the response to treatment 6

Safety and Efficacy

• Teriparatide has been shown to be safe and effective in increasing BMD and reducing the risk of fractures in patients with osteoporosis 3, 5
• However, treatment is not recommended for more than 2 years due to the potential risk of osteosarcoma 4
• Regular monitoring of serum calcium levels and BMD is necessary to ensure safe and effective treatment 5, 4