Recommended Dose of Teriparatide for Osteoporosis Treatment

The recommended dose of teriparatide for the treatment of osteoporosis is 20 mcg administered subcutaneously once daily. 1

Dosing Details

Teriparatide is administered as a 20 mcg subcutaneous injection once daily into the thigh or abdominal region 2, 1
The medication is available as an injection pen containing 620 mcg/2.48 mL (250 mcg/mL) in a single-patient-use pen that provides 28 daily doses of 20 mcg 1
Initial administration should be done under circumstances where the patient can sit or lie down if symptoms of orthostatic hypotension occur 1

Treatment duration should typically not exceed 2 years during a patient's lifetime 1
Extended treatment beyond 2 years should only be considered if a patient remains at or has returned to having a high risk for fracture 1
In clinical trials, teriparatide was typically administered for 18-24 months 3

Teriparatide is indicated for:

Treatment of postmenopausal women with osteoporosis at high risk for fracture or patients who have failed or are intolerant to other available osteoporosis therapy 1
Increase of bone mass in men with primary or hypogonadal osteoporosis at high risk for fracture or patients who have failed or are intolerant to other available osteoporosis therapy 1
Treatment of men and women with osteoporosis associated with sustained systemic glucocorticoid therapy at high risk for fracture or patients who have failed or are intolerant to other available osteoporosis therapy 1

Consider supplemental calcium and vitamin D based on individual patient needs 1
Recommended daily dietary allowances for calcium are 1,000-1,200 mg and for vitamin D are 600-800 IU for adults with osteoporosis 2

Teriparatide is typically used in patients with severe osteoporosis or who have had fractures 2
It is generally considered a second-line therapy after bisphosphonates in most treatment algorithms 2
For adults with very high fracture risk, teriparatide may be preferred over anti-resorptive agents (bisphosphonates or denosumab) 2

Teriparatide rapidly increases markers of bone formation, typically doubling by three months of treatment 4
Treatment with teriparatide 20 mcg daily has been shown to reduce the incidence of vertebral fractures by 65% and nonvertebral fragility fractures by 53% 3
Teriparatide increases spine bone mineral density by approximately 10% and hip bone mineral density by 3% 3
Long-term follow-up studies (10 years) have shown sustained reduction in fracture prevalence to levels similar to the general population 5

Contraindicated in patients with hypersensitivity to teriparatide or to any of its excipients 1
Use with caution in patients with increased risk of osteosarcoma, including those with open epiphyses, metabolic bone diseases including Paget's disease, bone metastases or history of skeletal malignancies, prior radiation therapy involving the skeleton, and hereditary disorders predisposing to osteosarcoma 1, 2
Avoid use in patients with hypercalcemic disorders or worsening cutaneous calcification 1
Consider risk/benefit in patients with active or recent urolithiasis due to risk of exacerbation 1
Not recommended for use in patients with cancer or history of malignancy prone to metastasize to bone 2

Most common adverse reactions (>10%) include arthralgia, pain, and nausea 1
Transient orthostatic hypotension may occur with initial doses 1
Hypercalcemia occurs in approximately 11% of patients but is usually transient 4
Monitor serum calcium, especially during the first three months of therapy 4

Not recommended during pregnancy; consider discontinuing when pregnancy is recognized 1
Breastfeeding is not recommended during treatment 1
Safety and effectiveness not established in pediatric patients; avoid use due to increased baseline risk of osteosarcoma 1