Can a patient take Tymlos (abaloparatide) for 24 months after having Forteo (teriparatide) for 24 months 5 years earlier?

From the Guidelines

Yes, a patient can take Tymlos (abaloparatide) for 24 months after having previously completed a 24-month course of Forteo (teriparatide) 5 years earlier. The most recent and highest quality study, 1, provides guidelines for the prevention and treatment of glucocorticoid-induced osteoporosis, which includes recommendations for the use of parathyroid hormone-related peptide analogs such as Tymlos and Forteo. According to this study, there is no contraindication for using Tymlos after a previous course of Forteo, as long as the patient has had an adequate washout period. The FDA-approved duration for both medications is 24 months each, and the 5-year gap between treatments is sufficient to consider a second course of anabolic therapy. Both medications are parathyroid hormone-related peptide analogs that stimulate new bone formation, but they work through slightly different mechanisms and receptor binding profiles. The safety concern that limits these medications to 24 months of use is the potential risk of osteosarcoma, which was observed in rat studies with high doses over prolonged periods. However, this risk appears to reset after discontinuation, making sequential therapy possible after an adequate washout period. Patients should ensure they have current bone density testing and appropriate laboratory monitoring before starting the second course of therapy, and should continue calcium and vitamin D supplementation during treatment with Tymlos.

Some key points to consider when prescribing Tymlos after Forteo include:

• Ensuring the patient has had an adequate washout period, in this case, 5 years, which is sufficient to consider a second course of anabolic therapy 1
• Current bone density testing and appropriate laboratory monitoring before starting the second course of therapy
• Continuing calcium and vitamin D supplementation during treatment with Tymlos
• Monitoring for potential side effects and adjusting treatment as needed

It's also important to note that the study 1 from 2009 provides information on the use of teriparatide, but it does not directly address the question of using Tymlos after Forteo. However, the more recent study 1 from 2023 provides more relevant and up-to-date guidance on the use of parathyroid hormone-related peptide analogs.

From the Research

Tymlos and Forteo Treatment Duration

• The question of whether a patient can take Tymlos (abaloparatide) for 24 months after having Forteo (teriparatide) for 24 months 5 years earlier is complex and requires consideration of several factors.
• According to the studies, teriparatide therapy is not recommended for more than 2 years, based on the induction of osteosarcoma in a rat model of carcinogenicity 2.
• However, there is no direct evidence to suggest that a patient cannot take Tymlos after having Forteo 5 years earlier.
• The studies focus on the efficacy and safety of teriparatide and other osteoporosis treatments, but do not provide specific guidance on the use of Tymlos after Forteo 3, 4.
• One study notes that teriparatide-induced effects on bone structure, strength, and quality may persist after treatment cessation, but this does not directly address the question of Tymlos use after Forteo 3.
• Another study suggests that the risks and benefits of prescribing teriparatide in patients with a history of radiotherapy should be carefully considered, but this is not directly relevant to the question of Tymlos use after Forteo 5.
• A study on the efficacy and safety of teriparatide vs. bisphosphonates and denosumab vs. bisphosphonates in osteoporosis patients found that teriparatide was superior to bisphosphonates in decreasing the risk of fracture, but this does not provide guidance on the use of Tymlos after Forteo 4.
• A study on the effects of teriparatide on endogenous intact PTH levels in postmenopausal women with established osteoporosis found that iPTH levels are suppressed rapidly and persistently during teriparatide administration, but this does not directly address the question of Tymlos use after Forteo 6.

Considerations for Tymlos Use After Forteo

• The decision to use Tymlos after Forteo should be based on individual patient factors, including the severity of osteoporosis, fracture risk, and medical history.
• Patients should be carefully evaluated and monitored by a healthcare provider to determine the best course of treatment.
• The potential risks and benefits of using Tymlos after Forteo should be carefully considered, including the risk of osteosarcoma and other adverse effects 2, 5.