Teriparatide Dosing for Osteoporosis Treatment
The recommended dose of teriparatide for osteoporosis treatment is 20 mcg administered subcutaneously once daily. 1
Indications and Administration
Teriparatide is indicated for:
- Treatment of postmenopausal women with osteoporosis at high risk for fracture or who have failed other osteoporosis therapy 1
- Increasing bone mass in men with primary or hypogonadal osteoporosis at high risk for fracture 1
- Treatment of men and women with glucocorticoid-induced osteoporosis at high risk for fracture 1
Administration should be via subcutaneous injection into the thigh or abdominal region 1
Initial administration should occur under circumstances where the patient can sit or lie down if symptoms of orthostatic hypotension occur 1
Treatment Duration and Supplementation
- Treatment duration should not exceed 2 years during a patient's lifetime unless the patient remains at or has returned to having a high risk for fracture 1
- Calcium (1,000-1,200 mg/day) and vitamin D (600-800 IU/day) supplementation should be considered based on individual patient needs 2, 1
Positioning in Treatment Algorithm
- Teriparatide is typically considered a second-line therapy after bisphosphonates for most patients with osteoporosis 2
- For patients with very high fracture risk, teriparatide may be preferred over anti-resorptive agents (bisphosphonates or denosumab) 2
- In glucocorticoid-induced osteoporosis, teriparatide is recommended after oral bisphosphonates when they are not appropriate 3
Efficacy
- Teriparatide has been shown to rapidly increase markers of bone formation and reduce the incidence of vertebral fractures by 65% and nonvertebral fragility fractures by 53% 4
- Treatment increases spine bone mineral density by approximately 10% and hip bone mineral density by about 3% 4
- Long-term follow-up studies have shown that fracture reduction benefits may persist after treatment completion 5
Contraindications and Warnings
- Avoid use 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 external beam or implant radiation therapy involving the skeleton
- Hereditary disorders predisposing to osteosarcoma 1
- Not recommended for patients with cancer or history of malignancy prone to metastasize to bone 2
- Avoid in patients with known hypercalcemic disorders 1
- Consider risk/benefit in patients with active or recent urolithiasis 1
Common Side Effects
- Most common adverse reactions (>10%) include arthralgia, pain, and nausea 1
- Transient orthostatic hypotension may occur with initial doses 1