Treatment of osteoporosis with teriparatide (Forteo)

Teriparatide has the disadvantage of needing to be administered by injection daily, something that many people are not comfortable doing. It is also very expensive, costing about $516 per month versus $65 for alendronate. The recommended dose is 20 micrograms daily, given into the thigh or abdomen. It comes in a preloaded pen with 28 doses. A doctor, nurse, or pharmacist should explain how to use it. It should be kept in the refrigerator. A new needle must be used for each injection, and the remaining medicine returned to the refrigerator. The pharmacist should also explain a way to safely dispose of needles.

The reason the drug must be taken every day is because the body eliminates it so quickly. The concentration in the bloodstream peaks about 30 minutes after injection. The half-life is abour one hour when administered by subcutaneous injection. Within three hours, the drug is down to such low levels that it is essentially gone. The body clears the drug as it normally clears external materials.

Duration of treatment is 18-24 months. Doctors evaluate progress during this period and may recommend continuing treatment. Teriparatide should not be combined with bisphosphonates.

The goals of osteoporosis treatment are generally to stop or slow bone density decline, to prevent fractures, and to control pain from the disease.

A 2006 study in the Journal of Drug Assessment concluded that although teriparatide is the most expensive therapy for preventing bone fractures in osteoporosis patients, it is on the "cost-effectiveness frontier" - meaning it is a good choice for some patients.

Surgeon General on Prevention and Treatment of Bone Diseases.

Recommendations released by the American College of Physicians in September 2008 included the statement that doctors should offer drugs to people with osteoporosis, and that doctors should consider preventative treatment for osteoporosis. The organization said teriparatide prevented spine fractures, but noted that evidence for other types of fractures is mixed.