"You want me to what? I don't have diabetes. Why do I need to give myself a shot everyday for my osteoporosis? Why can't I just take a pill like everyone else?"
This type of conversation is common when a healthcare provider recommends a medication called Forteo (teriparatide) to treat osteoporosis. Most people with osteoporosis do take a pill, either weekly or monthly to treat their bone loss and prevent fractures. Sometimes, the oral medications like Fosamax (alendronate), Actonel (risedronate) and Boniva (ibandronate) just aren't enough. Either the bone density is severely low or patients have been on oral medications that aren't providing enough improvement. There are also people who don't tolerate the oral medications due to side effects. In these cases, Forteo may be prescribed.
Building Bone to Reduce Risk of Fracture
Forteo works differently than the oral medications. Normal bone builds itself up and breaks itself down as a continual, balanced process known as bone turnover. With age, the balance shifts, causing more breakdown than the body can counteract. Osteoporosis occurs when the bone density decreases enough that the risk of fracture is greater than normal. Oral pills for osteoporosis help slow down bone turnover, increasing bone density and decreasing fracture risk.
Injectable Forteo is a synthetic version of parathyroid hormone, which the body normally produces to regulate calcium and phosphate. Instead of decreasing bone breakdown, Forteo actually helps to build bone. This also helps to prevent or decrease the risk of fractures. It is given in a daily injection using a specially-designed pen device that is very similar to an insulin pen that someone with diabetes might use. The needles are very small and thin; most people hardly feel the injections which are given in the thigh or abdomen. Patients often receive instruction on the injections through their healthcare provider or a special class sponsored by Llilly, the company that makes Forteo. Most people take Forteo daily for a total of two years.
Side Effects of Forteo
Most people tolerate Forteo very well. Some people do notice nausea, dizziness or a fast heartbeat. This usually improves after a few doses. Others may experience joint pains or leg cramps. Anyone with these symptoms should call their healthcare provider to see if the symptoms might be related to Forteo.
Animal studies have shown an increased risk of a cancerous bone tumor called osteosarcoma in rats that were given Forteo. So far, this risk does not seem to be increased in human patients taking Forteo.
Forteo is not for everyone. People who have had cancer of the bones should not take Forteo. Also, anyone who has had radiation to the bones or a disease called Paget's disease should avoid Forteo. Since this medication is similar to parathyroid hormone, patients with hyperparathyroidism or overactive parathyroid should not take Forteo. Pregnant women and children also should not be treated with Forteo.
Cost of Forteo
One significant disadvantage to Forteo is the cost. A monthly supply may be $700 to $800 or more. This can be a problem for people who do not have comprehensive prescription drug coverage. Another disadvantage for travelers is that it does require refrigeration. A travel case with cold packs is usually provided when the patient receives her injection training. It's helpful as long as the patient has access to a freezer to re-freeze the cold packs at the end of the day.
Bottom Line
Forteo is one weapon in the arsenal for treatment of osteoporosis. It is not usually the first option, but can be helpful when used in the right people. For further questions about Forteo, patients should contact their prescriber or pharmacist.
Reference: http://www.forteo.com
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