Forteo is a daily shot. That is a nuicence, but a small price to pay for the only Anabolic, the only osteoporosis medication which will increase bone mass in spongy (cancellous) bone. Diabetics give themselves a daily shot for the rest of their lives. Forteo is for only 2 years and uses a tiny insulin needle.
People worry about the warning that lab rats got Osteosarcoma after being given very high doses of Teriparatide for the equivalent of 70 human years. We have not seen this in humans, or chimps, or monkeys, or dogs. Rats have bones that grow all their lives. We do not give Forteo to growing humans, pregnant women, nursing women, persons with Paget’s Disease or unexplained elevated Alkaline Phosphatase, or persons who have had radiation to their bones.
Remember that you must take adequate Calcium, with food, spread out over 3 meals. You must take enough Vitamin D3 to be able to absorb Calcium. You must eat enough Protein for your OsteoBlasts to make new bone matrix.
Forteo (Teriparatide) increases the thickness of the struts making up spongy (cancellous) bone. Forteo is the only osteoporosis medication to do that. It also makes the hard outer shell (cortical bone) thicker. How? Forteo stimulates OsteoBlasts. They make bone matrix, the collagen protein that is more than 80% of bone.
Forteo also stimulates bone turnover. Healthy bone is constantly being resorbed and replaced. This allows bone to eliminate the micro-cracks that gradually accumulate with activity. Bone is strongest when it is a mixture of older more calcified (stiffer) material mixed thoroughly with younger less calcified (somewhat bendable) material. Cracks cannot enlarge. Strength is better. More force is required to fracture the bone.
Anabolic medication for osteoporosis actually increases bone thickness and strength! Antiresorptive medications for osteoporosis (Fosamax, Alendronate, Actonel, Atelvia, Boniva, Evista, Reclast, Prolia) only preserve bone.
We have talked about all of the Antiresorptive medications over the last 2 months. They are excellent treatment if slowing down the OsteoClasts (cells that eat away your bone) is sufficient. That is not always the case.
Now it is time to talk about something completely different. Anabolic medication stimulates the OsteoBlasts (cells that make new bone matrix). OsteoBlasts can rebuild your bones. If you have Fractures, your bones may need to be rebuilt.
Forteo (Teriparatide) is the only Anabolic medication for osteoporosis in the USA. Close cousins of Forteo are available in other countries.
You may need the Anabolic, Forteo, if you have a hip fracture, multiple other fractures, or if VFA testing reveals a Vertebral Compression Fracture. A DXA T-score well below -2.5 can be reason enough without fracture.
Glucocorticoid (Cortico-Steroid) medications (Prednisone, Steroid Inhalers) specifically supress OsteoBlasts (cells that make new bone). Stimulating the OsteoBlasts with the Anabolic, Forteo, can offset the bone loss from Steroid medications. Smoking also supresses OsteoBlasts, leading to bone loss. Stopping Smoking would be best, but Forteo can help.
Not everyone needs an Anabolic, but some individuals do. A Complete Bone Health Evaluation will tell you if an Anabolic is right for you.
More about Forteo (Teriparatide) next time.
Jay Ginther, MD
The “General Sherman” Giant Sequoia tree is the largest living tree, and the largest single living organism on earth. 275 feet tall, with a footprint 36 feet in diameter at ground level, and an estimated trunk volume of 52,500 cubic feet. Wow.
We were awed by the immense size of this and other trees nearly as large. Photos cannot properly picture these giants. You have to experience them in person. Even then they are difficult to comprehend. Their cousins, the Coastal Redwoods are taller, but nowhere near as wide.
We saw the giant sequoias last week when we went to our son’s wedding just 4 miles from the Mariposa Grove of giants in Yosemite National Park. The biggest are in Sequoia and King’s Canyon National Parks. I had not been there before. I am overwhelmed to have seen them now.
Humans caused serious harm to these trees by supressing natural lightning strike fires from the 1850s to 1970s. The undergrowth began to choke the giants and prevented new seedlings from growing. Although the most striking characteristic of these trees is huge fire scars 50 to 75 feet tall, they require fire to supress competition for water and nutrients.
Studying the growth rings of fallen trees reveals that they grow the fastest in the years just after fire scars. And those fire scars are every 5 to 13 years over the centuries before European settlement.
Wandering through the forest in the company of these giants (some over 3000 years old) is truly a trip to the Blue Zones.
Yosemite Valley is incredible. Kings Canyon is 1/3 deeper than the Grand Canyon. So much to see of the natural world.
Jay Ginther, MD