From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Forteo (teriparatide) should typically be discontinued 1-2 weeks before surgery. This medication, which stimulates bone formation, doesn't pose significant surgical risks, but the temporary pause is recommended as a precaution. After surgery, once the patient is stable and able to resume normal medications, Forteo can be restarted. The exact timing for resumption should be determined by the surgeon and may depend on the type of surgery performed. Forteo works by activating osteoblasts to build new bone tissue, which is particularly beneficial for patients with severe osteoporosis. The brief interruption in therapy around surgery shouldn't significantly impact its long-term effectiveness in treating osteoporosis. Patients should inform both their surgeon and the physician who prescribed Forteo about their upcoming surgery to receive personalized guidance on medication management during the perioperative period.
Key Considerations
- The decision to discontinue Forteo before surgery is based on the principle of minimizing potential risks, although the medication itself does not significantly increase surgical risks 1.
- The anabolic effects of teriparatide on bone have been demonstrated in several species, including increases in bone mass, structural integrity, bone diameter, and bone strength 2.
- Clinical efficacy of teriparatide was demonstrated in a randomized study comprising 1637 post-menopausal women with osteoporosis, showing a 65% and 35% reduction of the relative risk of vertebral and appendicular fractures, respectively, during 18 months of treatment 2.
- It is essential to consider the patient's overall health status, the type of surgery, and the potential benefits and risks of continuing or discontinuing Forteo before making a decision 3.
Management Recommendations
- Patients should be evaluated for vitamin D deficiency before surgery, as adequate vitamin D levels are crucial for bone health and may impact surgical outcomes 1.
- Teriparatide therapy should be used under the guidance of a healthcare provider, with monitoring for adverse effects such as hypercalcemia and urinary calcium excretion 4.
- The combination of antiresorptive medications and teriparatide should be approached with caution, as the effects of teriparatide do not require prior stimulation of bone resorption, and concurrent therapy with bisphosphonates may be avoided 3.