Teriparatide Treatment Protocol for Osteoporosis

Patient Selection and Treatment Protocol

The American College of Physicians recommends that teriparatide should be reserved for patients with severe osteoporosis at very high risk for fracture, administered as 20 mcg subcutaneously once daily for up to 24 months, followed by bisphosphonate therapy to maintain bone density gains 1
"Very high risk" patients are defined by older age (typically >74 years), recent fracture (within past 12 months), history of multiple clinical osteoporotic fractures, multiple risk factors for fracture, and failure of other available osteoporosis therapies 1

Teriparatide reduces the risk of any clinical fractures (27 fewer events per 1000 patients; high certainty), radiographic vertebral fractures (69 fewer events per 1000 patients; high certainty), and clinical vertebral fractures (45 fewer events per 1000 patients; low certainty) 1
Compared to bisphosphonates, teriparatide reduces radiographic vertebral fractures (66 fewer events per 1000 patients; moderate certainty) and may reduce any clinical fracture (46 fewer events per 1000 patients; low certainty) 1

The American College of Physicians recommends bisphosphonates as first-line therapy for osteoporosis, with denosumab considered for patients with contraindications to bisphosphonates 3, 4
Teriparatide should be reserved for patients with severe osteoporosis, patients who have had fractures, patients at very high risk for fracture, and patients who have failed or are intolerant to other osteoporosis therapies 1, 5
After teriparatide completion, patients should transition to bisphosphonate therapy to maintain bone density gains, as discontinuation without follow-up antiresorptive therapy results in rapid bone loss 1