From the Guidelines
Forteo (teriparatide) should typically be discontinued 24-48 hours before surgery. This medication is a parathyroid hormone analog used to treat osteoporosis by stimulating bone formation. The recommendation to hold Forteo before surgery is primarily based on theoretical concerns rather than strong evidence of surgical complications. Forteo has a short half-life of approximately 1 hour, so stopping it 1-2 days before surgery allows the medication to clear from your system. This timing minimizes any potential effects on bone metabolism during the surgical period.
Key Considerations
- The provided evidence does not directly address the management of Forteo in the perioperative period 1.
- However, based on the general principles of managing medications with potential effects on bone metabolism, it is reasonable to consider holding Forteo before surgery.
- The decision to hold Forteo should be individualized based on the patient's specific situation, including the type of surgery, overall health status, and osteoporosis severity.
Post-Surgery Management
After surgery, you can usually resume Forteo once you are stable and able to self-administer the injection, typically within a few days post-operation. However, this recommendation should not replace the specific instructions from your surgeon or endocrinologist, who may adjust this timing based on your particular surgical procedure, overall health status, and osteoporosis severity. Be sure to discuss your Forteo management with your healthcare providers well before your scheduled surgery to develop a personalized plan.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Holding Forteo Pre-Surgery
- The use of Forteo (teriparatide) in patients with osteonecrosis of the jaw has been studied in several research papers 2, 3, 4, 5.
- Teriparatide is a synthetic polypeptide hormone that stimulates bone formation and has been shown to improve symptoms of osteonecrosis of the jaw in patients with advanced bisphosphonate-related osteonecrosis of the jaw 2.
- Studies have also shown that teriparatide can be effective in treating medication-related osteonecrosis of the jaw (MRONJ) around dental implants, with once-weekly administration potentially minimizing side effects and patient discomfort 4.
- A clinical case series found that daily or weekly teriparatide treatment was beneficial for exposed bony MRONJ lesions, with a shorter healing period compared to standard conservative management 5.
- The treatment of MRONJ is challenging, and standard treatment guidelines have yet to be established, but teriparatide may be a useful adjunctive therapy in the management of MRONJ 6, 3, 5.
Teriparatide Administration
- Teriparatide can be administered daily or weekly, with both regimens showing effectiveness in treating MRONJ 4, 5.
- The dosage of teriparatide used in studies ranges from 20 μg to 56.5 μg per injection 4, 5.
- The treatment period with teriparatide can vary, but studies have shown that it can be effective in shortening the treatment period for MRONJ compared to standard conservative therapy 5.
Safety and Efficacy
- Teriparatide is generally well-tolerated, with favorable treatment compliance rates 6.
- Studies have shown that teriparatide can be effective in reducing the risk of fractures and improving bone mineral density in patients with osteoporosis 6.
- However, the high acquisition cost of teriparatide and limitations on the length of treatment mean that it is best reserved for patients with osteoporosis at high risk of fracture or those who have unsatisfactory responses to or intolerance of other osteoporosis therapies 6.