Revealing the therapeutic potential of teriparatide: a review

Authors

  • Sushant Srivastava Department of Orthopaedics, MGM Medical College, Mata Gujri University, Kishanganj, Bihar, India
  • Arvind Kumar Department of Orthopaedics, MGM Medical College, Mata Gujri University, Kishanganj, Bihar, India
  • Vishal Kundnani Department of Orthopaedics, Lilavati Hospital, Mumbai, Maharashtra, India; Department of Orthopaedics, Bombay Hospital, Mumbai, Maharashtra, India
  • Amit Ajgaonkar Department of Orthopaedics, BDBA Hospital, Kandivali, Mumbai, Maharashtra, India; Zenith Hospital, Malad, Mumbai, Maharashtra, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20241128

Keywords:

Teriparatide off-label treatment, Fractures, Cancer, Medication-related osteonecrosis

Abstract

Teriparatide is an FDA-approved medication for osteoporosis that presents promising results in treating various musculoskeletal conditions. It helps in improving the bone mineral density and preventing fractures in individuals with osteoporosis. Its effectiveness in treating non-union and delayed union fractures, atypical femoral fractures, and spinal fusion procedures makes it valuable in improving bone healing and reducing complications. Teriparatide also improves bone density and strength in individuals with osteogenesis imperfecta, helps prevent and treat hypocalcaemia post-thyroidectomy, and helps in the management of hypoparathyroidism. In MRONJ, teriparatide improves lesion resolution and reduces bony defects. Furthermore, it potentially prevents bone metastasis in cancer patients without stimulating tumour growth. Nevertheless, teriparatide may cause short-term side effects like nausea and long-term concerns pertaining to the risk of osteosarcoma. Recent European alliance of associations for rheumatology guidelines have highlighted teriparatide's superior effectiveness in achieving bone mineral density thresholds and reducing fracture risks. Further clinical trials are necessary to determine optimal dosages and treatment durations of teriparatide. The off-label use of teriparatide should be considered only under the guidance of a healthcare professional when standard options are unavailable or inadequate.

References

Drug Approval Package: Forteo teriparatide (rDNA origin) Injection. Available at: https://www. accessdata.fda.gov/drugsatfda_docs/nda/2002/21-318_Forteo.cfm. Accessed on 31 August 2023.

Fortseo. Available at: https://www.ema.europa.eu/en/ medicines/human/EPAR/forsteo# assessment-history-section. Accessed on 21 August 2023.

New Drugs Approved by CDSCO. Available at: https://cdscoonline.gov.in/CDSCO/Drugs. Accessed on 21 August 2023.

Pavone V, Testa G, Giardina SMC, Vescio A, Restivo DA, Sessa G. Pharmacological Therapy of Osteoporosis: A Systematic Current Review of Literature. Front Pharmacol. 2017;8:803.

Leali PT, Balsano M, Maestretti G, Brusoni M, Amorese V, Ciurlia E, et al. Efficacy of teriparatide vs neridronate in adults with osteogenesis imperfecta type I: a prospective randomized international clinical study. Clin Cases Miner Bone Metab. 2017;14(2):153-6.

Han S, Wen SM, Zhao QP, Huang H, Wang H, Cong YX, et al. The Efficacy of Teriparatide in Improving Fracture Healing in Hip Fractures: A Systematic Review and Meta-Analysis. Biomed Res Int. 2020; 2020:591.

Drakopoulos P, Flevas DA, Galanopoulos IP, Lepetsos P, Zafeiris C. Off-Label Use of Teriparatide in Spine. Cureus. 2021;13(7):e16522.

Agnihotri R, Gaur S. Applications of Teriparatide for Alveolar Bone Regeneration: A Systematic Review. J Int Soc Prev Community Dent. 2021;11(6):639-43.

Huang TW, Chuang PY, Lin SJ, Lee CY, Huang KC, Shih HN, et al. Teriparatide Improves Fracture Healing and Early Functional Recovery in Treatment of Osteoporotic Intertrochanteric Fractures. Medicine (Baltimore). 2016;95(19):e3626.

Orwoll ES, Shapiro J, Veith S, Wang Y, Lapidus J, Vanek C, et al. Evaluation of teriparatide treatment in adults with osteogenesis imperfecta. J Clin Invest. 2014;124(2):491-8.

Understanding Unapproved Use of Approved Drugs “Off Label”. Available at: https://www.fda.gov/ patients/learn-about-expanded-access-and-other-treatment-options/understanding-unapproved-use-approved-drugs-label. Accessed on 21 August 2023.

Shigenobu K, Hashimoto T, Kanayama M, Ohha H, Yamane S. The efficacy of osteoporotic treatment in patients with new spinal vertebral compression fracture pain, ADL, QOL, bone metabolism and fracture-healing - In comparison with weekly teriparatide with bisphosphonate. Bone Rep. 2019;11:100217.

Marin F. Treatment of chronic nonunion of a sternal fracture with teriparatide. Ann Thorac Surg. 2021; 111(1):e41-2.

Bednar DA. Teriparatide treatment of a glucocorticoid-associated resorbing nonunion of a type III odontoid process fracture: a case report. J Spinal Disord Tech. 2013;26(8):E319-22.

Thomas JD, Kehoe JL. Bone Nonunion. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2023.

Atiq G. Treatment of long bone fractures with surgical implant generation network (sign) nail. Rawal Med J. 2003;37(2):176-8.

Chintamaneni S, Finzel K, Gruber BL. Successful treatment of sternal fracture nonunion with teriparatide. Osteoporos Int. 2010;21(6):1059-63.

Marin F. Treatment of chronic nonunion of a sternal fracture with teriparatide. Ann Thorac Surg. 2021; 111(1):e41-2.

Freeland AE, Jabaley ME, Hughes JL. Delayed Union, Nonunion, and Pseudarthrosis. In: Stable Fixation of the Hand and Wrist. New York: Springer; 1986:161-78.

Gariffo G, Bottai V, Falcinelli F, Di Sacco F, Cifali R, Troiano E, et al. Use of Teriparatide in preventing delayed bone healing and nonunion: a multicentric study on a series of 20 patients. BMC Musculoskelet Disord. 2023;24:184.

Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344(19):1434-41.

Bernardor J, Flammier S, Cabet S, Lemoine S, Chapurlat R, Molin A, et al. Intermittent Bi-daily sub-cutaneous teriparatide administration in children with hypoparathyroidism: a single-center experience. Front Pediatr. 2021;9:764.

Shane E, Burr D, Ebeling PR, Abrahamsen B, Adler RA, Brown TD, et al. Atypical subtrochanteric and diaphyseal femoral fractures: report of a task force of the American Society for Bone and Mineral Research. J Bone Miner Res. 2010;25(11):2267-94.

Spinal Fusion. Available at: https://orthoinfo.aaos.org/ en/treatment/spinal-fusion. Accessed on 21 August 2023.

Fatima N, Massaad E, Hadzipasic M, Shankar GM, Shin JH. Assessment of the efficacy of teriparatide treatment for osteoporosis on lumbar fusion surgery outcomes: a systematic review and meta-analysis. Neurosurg Rev. 2021;44(3):1357-70.

Marini JC, Blissett AR. New genes in bone development: what’s new in osteogenesis imperfecta. J Clin Endocrinol Metab. 2013;98(8):3095-103.

Gatti D, Rossini M, Viapiana O, Povino MR, Liuzza S, Fracassi E, et al. Teriparatide treatment in adult patients with osteogenesis imperfecta type I. Calcif Tissue Int. 2013;93(5):448-52.

Schafer AL, Shoback DM. Hypocalcemia: Diagnosis and Treatment. In: Endotext. South Dartmouth: MDText.com Inc; 2000.

Rosato L, Avenia N, Bernante P, De Palma M, Gulino G, Nasi PG, et al. Complications of thyroid surgery: analysis of a multicentric study on 14,934 patients operated on in Italy over 5 years. World J Surg. 2004; 28(3):271-6.

Eismontas V, Slepavicius A, Janusonis V, Zeromskas P, Beisa V, Strupas K, et al. Predictors of postoperative hypocalcemia occurring after a total thyroidectomy: results of prospective multicenter study. BMC Surg. 2018;18:55.

Pfleiderer AG, Ahmad N, Drapers MR, Vrotsou K, Smith WK. The Timing of Calcium Measurements in Helping to Predict Temporary and Permanent Hypocalcaemia in Patients Having Completion and Total Thyroidectomies. Ann R Coll Surg Engl. 2009; 91(2):140-6.

Shah M, Bancos I, Thompson GB, Richards ML, Kasperbauer JL, Clarke BL, et al. Teriparatide Therapy and Reduced Postoperative Hospitalization for Postsurgical Hypoparathyroidism. JAMA Otolaryngol Head Neck Surg. 2015;141(9):822-7.

Palermo A, Mangiameli G, Tabacco G, Longo F, Pedone C, Briganti SI, et al. PTH(1-34) for the Primary Prevention of Postthyroidectomy Hypocalcemia: The THYPOS Trial. J Clin Endocrinol Metab. 2016; 101(11):4039-45.

Hans SK, Levine SN. In: Hypoparathyroidism. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2023.

Puliani G, Hasenmajer V, Simonelli I, Sada V, Pofi R, Minnetti M, et al. Safety and Efficacy of PTH 1-34 and 1-84 Therapy in Chronic Hypoparathyroidism: A Meta-Analysis of Prospective Trials. J Bone Miner Res. 2022;37(7):1233-50.

Winer KK, Ko CW, Reynolds JC, Dowdy K, Keil M, Peterson D, et al. Long-term treatment of hypoparathyroidism: a randomized controlled study comparing parathyroid hormone-(1-34) versus calcitriol and calcium. J Clin Endocrinol Metab. 2003; 88(9):4214-20.

Khan AA, Bilezikian JP, Brandi ML, Clarke BL, Gittoes NJ, Pasieka JL, et al. Evaluation and Management of Hypoparathyroidism Summary Statement and Guidelines from the Second International Workshop. J Bone Miner Res. 2008;37: 2568-85.

Ruggiero SL, Dodson TB, Fantasia J, Goodday R, Aghaloo T, Mehrotra B, et al. American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update. J Oral Maxillofac Surg. 2014;72(10):1938-56.

Khan AA, Morrison A, Hanley DA, Felsenberg D, McCauley LK, O’Ryan F, et al. Diagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus. J Bone Miner Res. 2015;30(1):3-23.

Ferreira L, Abreu LG, Calderipe CB, Martins MD, Schuch LF, Vasconcelos ACU. Is teriparatide therapy effective for medication-related osteonecrosis of the jaw? A systematic review and meta-analysis. Osteoporos Int. 2021;32(12):2449-59.

Sim IW, Borromeo GL, Tsao C, Hardiman R, Hofman MS, Hjelle CP, et al. Teriparatide promotes bone healing in medication-related osteonecrosis of the jaw: A placebo-controlled, randomized trial. J Clin Oncol. 2020;38(26):2971-80.

Li C, Yang D, Meng Y, Hao S. Effect of parathyroid hormone (1-34) on bone metastasis of lung cancer cells in mice. Nan Fang Yi Ke Da Xue Xue Bao. 2014; 34(9):1295-300.

Swami S, Johnson J, Bettinson LA, Kimura T, Zhu H, Albertelli MA, et al. Prevention of breast cancer skeletal metastases with parathyroid hormone. JCI Insight. 2017;2(17):e90874.

Capriani C, Irani D, Bilezikian JP. Safety of osteoanabolic therapy: a decade of experience. J J Bone Miner Res. 2012;27(12):2419-28.

Hodsman AB, Bauer DC, Dempster DW, Dian L, Hanley DA, Harris ST, et al. Parathyroid hormone and teriparatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use. Endocr Rev. 2005;26(5):688-703.

Adami G, Bertelle D, Fassio A, Benini C, Gatti D, Viapiana O, et al. OP0242 proportion of patients reaching the bone mineral density (BMD) surrogate threshold effect (STE) with bisphosphonates, denosumab and teriparatide. Ann Rheumat Dis. 2023; 82:161-2.

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Published

2024-04-29

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Review Articles