Posts Tagged ‘Teriparatide’
GIOP is Glucocorticoid Induced OsteoPorosis. Cortisone, Prednisone, and many Inhalers for Asthma or COPD are glucocorticoids. Therefore, Glucocorticoid Induced OsteoPorosis is a particularly aggressive form of osteoporosis that affects all ages, not just older adults.
Glucocorticoids suppress OsteoBlasts, the cells that make new bone. Even the normal rate of bone turnover required for good bone maintenence and repair of microcracks becomes a problem when new bone formation is suppressed. Persons with GIOP have a rapid decline in bone quality and strength. What can be done?
A reader has asked about bone cancer and Forteo.
Osteosarcoma is a rare bone cancer. Lilly has endowed a 15-year independent study (suggested by the FDA) of all Osteosarcoma patients in Cancer Registries, looking for individuals who have taken Forteo. The halfway point results from June 2004 through Sept 2011 were published in JBMR in Dec 2012. Of the 1448 persons who had Osteosarcoma during that time period, not one had taken Forteo.
The “black box” warning on the Forteo (Teriparatide) label refers to studies of rats, not humans. These rats very commonly get osteosarcoma without any medication. The rats were given doses 3 to 20 times the human dose for the equivalent of 70 human years. Rats’ bones never stop growing. Growing bones are particularly vulnerable to osteosarcoma. Humans are different from rats.
I have been on the road with presentations in South Dakota and Southern Illinois recently. SD is state # 10 for me. I teach health care providers about the role for the Anabolic, Teriparatide (Forteo), in the treatment of specific patients. However, I also present a very important message about ALL patients.
A fracture, ANY FRACTURE, means that the patient deserves a Bone Health Evaluation. A fall from a standing height or other minor trauma is obviously a possible Fragility Fracture. But even a fracture during sports deserves at least a check of Calcium in diet and supplements, and a blood test for Vitamin D level.
Studies of combinations of osteoporosis medications expanded at the American Society for Bone and Mineral Research (ASBMR) 2012. Previous meetings featured alternating the anabolic, Teriparatide (Forteo) with a Bisphosphonate Antiresorptive, usually Alendronate (generic Fosamax), and, more recently, simultaneous Alendronate and Forteo. This time we heard about the first study of Denosumab (Prolia) combined with Forteo. [Disclosure: I am on the Orthopedic Advisory Board for Prolia, and Speakers Bureau for Forteo]
The Bone Mineral Density (BMD) increase at one year was much better for the combination than for either drug alone. This is the same effect we have seen with previous combinations, but higher BMD numbers. This study had small numbers of patients (<200), and a short period of time (<2 years). It is not clear, whether the greater BMD of this combination is of any significance, and how well it will hold up over time. Also, BMD is not the whole story.