Points to remember about Forteo are:
1. This is an anabolic drug causing bone formation by stimulating preosteoblasts instead of preventing bone resorption as seen with other agents such as calcitonin and bisphosphonates.
2. Clinically Forteo appears to be very effective as I have seen patients stop fracturing after only four months of therapy with Forteo. Bone formation actually seem to occur very rapidly and peaks at 6 to 9 months.
3. Cost can be a significant impediment, but the drug company usually finds a way to help.
4. Ideal candidates are those with a T score of – 2.5 or lower on DXA scan with a fracture, those with T score of – 3.5 or lower without a fracture or those who could not tolerate Bisphosphonates or Prolia.
5. Vitamin D level, along with base line labs including alkaline phosphatase, uric acid, phosphorous, calcium, creatinine, 24 urine calcium, creatinine clearance or eGFR should be obtained prior to start of treatment. Blood pressure and pulse should be checked after the first injection as it can cause orthostatic hypotension.
6. Forteo should be avoided in patients with the following:
– history of skeletal radiation
– previous cancer history
– metabolic bone disease such as Paget’s disease
– elevation of alkaline phosphatase
– elevation of uric acid or history of gout
– elevation of serum calcium
– elevation of urinary calcium
– history of kidney stones
– renal insufficiency
– hyperparathyroidism both primary and secondary
7. The following should be monitored periodically during treatment with Forteo:
– calcium to be done 24 hours after the injection
– uric acid
– eGFR
– alkaline phosphatase
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