[Teriparatide: an anabolic drug for the treatment of patients with osteoporosis].
The management of osteoporosis has been dominated by the use of antiresorptive agents, such as bisphosphonates and raloxifene, which have been shown to effectively reduce the risk of osteoporotic fractures. Teriparatide, a recombinant human parathyroid hormone, has recently become available. It has an altogether different action. Teriparatide is an anabolic agent that primarily stimulates bone formation. This leads to an increase in bone volume and the bone structure and microarchitecture is restored by an increase in trabecular thickness and an increase in the number of connections between trabeculae. Clinically relevant studies on teriparatide in postmenopausal women and in men have shown that it significantly lowers the risk of fracture. Teriparatide should not be combined with bisphosphonates. There are no clear recommendations on the order of treatment with teriparatide and bisphosphonates. The high costs ofteriparatide have slowed the trajectory from registration to reimbursement in the Netherlands. Since 1 February 2005 teriparatide may be prescribed for postmenopausal women with serious osteoporosis i.e. with a minimum of 1 osteoporotic fracture who (a) despite treatment with bisphosphonates or raloxifene after 2 prolapsed vertebrae once again have 1 or more fractures (inadequate response); (b) can tolerate neither bisphosphonates nor raloxifene; (c) are prescribed the drug by their treating medical specialist.
Lems
W F
WF
VU Medisch Centrum, Postbus 7057, 1007 MB Amsterdam. wf.lems@vumc.nl
Hamdy
N A T
NA
Netelenbos
J C
JC
D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000188:drug therapy*; D015663:Osteoporosis, Postmenopausal / Q000188:drug therapy; D019379:Teriparatide / Q000627:therapeutic use*; D016896:Treatment Outcome
D050071:Bone Density Conservation Agents; D019379:Teriparatide