Men's Osteoporosis Support Group

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Teriparatide retreatment option found effective

J Bone Miner Res. 2008 Dec 29. [Epub ahead of print] Retreatment with Teriparatide One Year After the First Teriparatide Course in Patients on Continued Long-Term Alendronate. Cosman F and others. PMID: 19113926. The general recommendation for individuals at high risk for fracture from severe osteoporosis is to use teriparatide (Forteo) for one year followed by one of the bisphosphonates. This study evaluated the option of reinstituting the teriparatide after a year of post-teriparatide bisphosphonate therapy. This study involved women with osteoporosis who had completed 15 months of teriparatide followed by a year of bisphosphonate therapy. They were still deemed at high risk for fracture, and had an additional 15 months of daily teriparatide therapy. The authors noted, "We conclude that retreatment with teriparatide stimulates bone formation and increases spine BMD to a similar extent as seen during the original teriparatide course. Retreatment with teriparatide may be a viable option for some patients with severe osteoporosis who have received prior teriparatide therapy."

Editor's comments. This gives individuals at high risk for an osteoporotic fracture the option of another round of Forteo therapy after they have completed a year of bisphosphonates. Presumably they would then go back on the bisphosphonates for all subsequent years. Although additional studies might be done to show that this cyclical dosing of the two medications could possibly be done for additional cycles, if needed. If you are in that group that is still at a high fracture risk after one cycle of Forteo, I recommend you discuss this study with your care provider.

A 2005 Update described the literature which showed the effectiveness of continuing bisphosphonate therapy after one year of Forteo. Another 2005 Update showed that cyclic 3 months on and 3 months off therapy with Forteo was almost as effective as continuous Forteo injections over a 15-month period. The women in the December 29 article above were most likely in this cyclic study, but were not continued on that form of therapy, instead all women received the daily injections for 15 months. It would have been interesting to see if the cyclic injections were as effective the second time around since that treatment method offers considerable financial and convenience options to the patient. The cyclic method resulting in 50% fewer injections with almost equal results.

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