OsteoEd

Practice Cases

Teriparatide

Heidi Powell, MD Literature reviewed November 15, 2007. Updated November 15, 2008

A 72 year old woman with osteoporosis and a history of a fragility fracture developed myalgias on alendronate. She discontinued the alendronate and wants to know if there is another medication she should try. Her medical problems include HTN, hypercholesterolemia and h/o DVT.

Medications: hydrochlorothiazide, lovastatin

Click an answer under each question.

  1. Which of the following osteoporosis medications would you recommend at this time?

  2. You tell her that teriparatide does not come in an oral form, but requires daily subcutaneous injections. She is willing to try using it but wants to know how it works. You tell her that it is an:

    • Option A Anti-resorptive medication similar to the bisphosphonates
    • Option B Anabolic medication that builds bones
    • Option C Anti-resorptive medication similar to estrogen
    • Option D Agent with both anti-resorptive and anabolic properties

  3. She wants to know if it will decrease her risk of having another fracture. Teriparatide (as compared to placebo):

    • Option A Decreases hip fractures by 25%
    • Option B Decreases vertebral fractures by 65% and nonvertebral fractures by 53%
    • Option C Decreases hip fractures by 30% and decreases vertebral fractures by 50%
    • Option D Increases BMD, but fracture risk reduction is unknown

  4. Is there any evidence that combing teriparatide with a bisphosphonate will increase BMD or decrease fracture rates more than with teriparatide alone?

    • Option A BMD increases in the spine only with the combination but fracture rate is not affected
    • Option B Vertebral fracture rate is reduced with the combination but there is no affect on hip fracture rate
    • Option C There is no data on fracture risk reduction with the combined medications
    • Option D BMD increases more with combined therapy in both the spine and hip, but fracture rate is not changed

  5. She wants to know the potential side effects of teriparatide before starting it. Which of the following occur more frequently with the 20 ug daily teriparatide as compared to placebo?

  6. Are there any contraindications to using teriparatide?

  7. The maximum duration of use of teriparatide that is recommended by the FDA is:

Key Points
Last edited July 03, 2009