The role of teriparatide in sequential and combination therapy of osteoporosis

Abstract

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.

Effects of Raloxifene on the Proliferation and Apoptosis of Human Aortic Valve Interstitial Cells

“…As a new generation of SERM, RAL is currently used to treat osteoporosis in females after menopause [17, 18]. RAL has certain effects on cardiovascular diseases, and previous studies revealed that RAL and other SERMs improve the function of vascular endothelial cells [19, 20], dilate the coronary artery [8, 21], and regulate blood fat [22].…”

Effects of combined teriparatide and zoledronic acid on posterior lumbar vertebral fusion in an aged ovariectomized rat model of osteopenia

“…In this study, we used an 12‐month old OVX rat model 10 month after ovariectomy with more severe osteopenia than that in the established osteopenic animal model 2 month post‐OVX. Clinically, bisphosphonates (BPs) are the first‐line treatment for osteoporosis, while TPTD is approved for failure of BPs, or for severe osteoporosis . Furthermore, it is possible that the 12‐month‐old rat could be a better model of human osteoporosis because the bone remodeling processes could prevail over bone modeling .…”

“…Clinically, bisphosphonates (BPs) are the first-line treatment for osteoporosis, while TPTD is approved for failure of BPs, or for severe osteoporosis. [27][28][29] Furthermore, it is possible that the 12-month-old rat could be a better model of human osteoporosis because the bone remodeling processes could prevail over bone modeling. 30 in clinical practices, most osteoporosis patients are aged postmenopausal women, age-related, and OVX induced decrease of BMD contribute simultaneously to the pathogenesis of osteoporosis.…”

Effect of teriparatide treatment on endothelial function, glucose metabolism and inflammation markers in patients with postmenopausal osteoporosis

“…[3][4][5] There are a number of studies proving beneficial anabolic effect of intermittent admission of teriparatide on bone formation and bone architecture in severe osteoporotic patients. [3][4][5][6][7] It is well known that PTH is an independent determinant of insulin resistance index and increase in plasma PTH (hyperparathyroidism) causes abnormal glucose metabolism. 8,9 Hyperparathyroidism is also associated with hyperlipidaemia, hyperglycaemia and cardiovascular complications like hypertension and left ventricular hypertrophy.…”