The role of teriparatide in sequential and combination therapy of osteoporosis

Osteoporosis is complicated by the occurrence of fragility fractures. Over past years, various treatment options have become available, mostly potent antiresorptive agents such as bisphosphonates and denosumab. However, antiresorptive therapy cannot fully and rapidly restore bone mass and structure...

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Bibliographic Details
Published in:Swiss medical weekly 2014-06, Vol.144 (2324), p.w13952-w13952
Main Authors: Meier, Christian, Lamy, Olivier, Krieg, Marc-Antoine, Mellinghoff, Hans-Ulrich, Felder, Markus, Ferrari, Serge, Rizzoli, René
Format: Article
Language:English
Subjects:
Bone Density Conservation Agents - therapeutic use
combination therapy
Diphosphonates - therapeutic use
Drug Therapy, Combination
Female
fracture risk
Humans
Male
osteoporosis
Osteoporosis - drug therapy
Raloxifene Hydrochloride - therapeutic use
teriparatide
Teriparatide - therapeutic use
Treatment Failure
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Summary:Osteoporosis is complicated by the occurrence of fragility fractures. Over past years, various treatment options have become available, mostly potent antiresorptive agents such as bisphosphonates and denosumab. However, antiresorptive therapy cannot fully and rapidly restore bone mass and structure that has been lost because of increased remodelling. Alternatively recombinant human parathyroid hormone (rhPTH) analogues do increase the formation of new bone material. The bone formation stimulated by intermittent PTH analogues not only increases bone mineral density (BMD) and bone mass but also improves the microarchitecture of the skeleton, thereby reducing incidence of vertebral and nonvertebral fractures. Teriparatide, a recombinant human PTH fragment available in Switzerland, is reimbursed as second-line treatment in postmenopausal women and men with increased fracture risk, specifically in patients with incident fractures under antiresorptive therapy or patients with glucocorticoid-induced osteoporosis and intolerance to antiresorptives. This position paper focuses on practical aspects in the management of patients on teriparatide treatment. Potential first-line indications for osteoanabolic treatment as well as the benefits and limitations of sequential and combination therapy with antiresorptive drugs are discussed.
ISSN:1424-7860
1424-3997
DOI:10.4414/smw.2014.13952