From the Guidelines
Anabolic medications for osteoporosis, including teriparatide (Forteo), abaloparatide (Tymlos), and romosozumab (Evenity), are recommended for patients with severe osteoporosis, those at high risk for fractures, or those who have failed or cannot tolerate other osteoporosis treatments, as they build new bone tissue rather than just preventing bone loss 1.
Key Points
- These medications work by stimulating osteoblasts (bone-building cells) to increase bone formation and improve bone microarchitecture.
- Teriparatide and abaloparatide are typically administered as daily subcutaneous injections (20 mcg for teriparatide, 80 mcg for abaloparatide) for up to 24 months.
- Romosozumab is given as monthly subcutaneous injections (210 mg) for 12 months.
- Common side effects include nausea, dizziness, leg cramps, and hypercalcemia.
- These medications should be used with caution in patients with a history of bone cancer or radiation therapy to the skeleton, as they carry a theoretical risk of osteosarcoma based on animal studies.
- Adequate calcium and vitamin D supplementation should be maintained during treatment.
Recommendations
- For adults with very high fracture risk, anabolic agents (parathyroid hormone [PTH] and PTH-related protein [PTHrP]) are conditionally recommended over antiresorptive agents (BP or denosumab [DEN]) 1.
- In adults ≥40 years of age at high risk of fracture, DEN or PTH/PTHrP are conditionally recommended over BP 1.
- A sequential therapy starting with a bone-forming agent followed by an anti-resorptive agent should be considered for men at a very high risk of fracture 1.
From the FDA Drug Label
The anabolic effect of abaloparatide was due to the predominant increase in osteoblastic bone formation and was evidenced by increases in trabecular thickness and/or cortical thickness due to endosteal bone apposition. The anabolic effect of EVENITY wanes after 12 monthly doses of therapy. Anabolic agents for osteoporosis are:
- Abaloparatide
- Romosozumab (EVENITY) These anabolic agents work by increasing bone formation and bone mass, which can help to reduce the risk of fractures in patients with osteoporosis 2 3.
From the Research
Anabolic Agents for Osteoporosis
- Anabolic agents, such as teriparatide and abaloparatide, have been shown to improve bone mass and architecture, as well as reduce fracture risk, to a greater degree than traditional antiresorptive therapies 4, 5.
- These agents increase bone density, improve bone strength, and reduce fracture risk by increasing osteoblastic bone formation 5.
- Teriparatide, abaloparatide, and romosozumab are examples of anabolic agents used to treat osteoporosis, each with unique pharmacological properties 5.
Types of Anabolic Agents
- Teriparatide is a human recombinant parathyroid hormone (PTH) 1-34, which has been shown to increase bone mineral density and reduce fracture risk 4, 6, 7.
- Abaloparatide is a synthetic parathyroid-related peptide (PTHrP) that has recently become available for use in treating osteoporosis 4, 5.
- Romosozumab is a humanized monoclonal antibody to sclerostin that has a "dual effect" of increasing bone formation while decreasing bone resorption 5.
Administration and Efficacy
- Anabolic agents are typically administered via daily subcutaneous injections, which can be a challenge in older women 8.
- A new oral robotic pill has been developed to deliver teriparatide with high bioavailability, which may improve administration and efficacy 8.
- Clinical trials have shown a favorable balance of expected benefits and possible risks for anabolic therapy, with greater benefit when initial treatment is with an anabolic agent followed by an antiresorptive drug 5.