Teriparatide/Abaloparatide: Therapy completion
PEARL: Teriparatide/Abaloparatide need to be following by another osteoporosis treatment to maintain gains! The benefits of anabolic therapy are quickly lost after discontinuation .” (JCEM 2019 – Teriparatide and Abaloparatide) Teriparatide or Abaloparatide should be …
Teriparatide/Abaloparatide: Worsening BMD
If the BMD is worsening (outside the margin of the least significant change), this should prompt a reevaluation of teriparatide/abaloparatide therapy. Common causes to consider: Medication nonadherence – teriparatide/abaloparatide requires daily subcutaneous injections There is …
Teriparatide/Abaloparatide: BMD after initiation
There is no consensus on the optimal frequency of monitoring and preferred site to monitor (UpToDate – Guidelines for monitoring response to therapy) Recommendations range from against monitoring (ACP) to every one to two years …
Teriparatide/Abaloparatide: Initiation
Initiate Teriparatide SQ 20 mcg daily or Abaloparatide SQ 80 mcg daily with a maximum duration of 2 years Unlike denosumab or romosozumab, teriparatide and Abaloparatide can be self administered Administer as a subcutaneous injection …
Teriparatide/Abaloparatide: Risk of osteosarcoma
Pearl: Teriparatide had and abaloparatide has a black box warning for risk of osteosarcoma due to an increase incidents in rats. So far, the rates of osteosarcoma have not been higher than expected in the …
Denosumab: Continuation or Bisphosphonate Transition
After 5-10 years, the use of denosumab can be reevaluated based on risk of facture. If a patient is improving and content to continue denosumab, therapy can be continued indefinitely acknowledging that there is limited …
Denosumab: Worsening BMD on therapy
PEARL: If the BMD is worsening (outside the margin of the least significant change), this should prompt a reevaluation of denosumab therapy Common causes to consider: Medication nonadherence – denosumab requires administration by health care …
Denosumab: BMD after initiation
There is no consensus on the optimal frequency of monitoring and preferred site to monitor (UpToDate – Guidelines for monitoring response to therapy) Recommendations range from against monitoring (American College of Physicians) to every one …
Denosumab: Initiation
If at risk for hypocalcemia, labs required within 14 days of each dose: Calcium, magnesium, phosphorus Each dose must be given every 6months +/- 1 month to avoid rebound risk of fractures Each dose must …
Denosumab: Correct Risk of Hypocalcemia
If serum calcium is low, evaluate etiology Consider parathyroid, thyroid, malabsorption Evaluate calcium and vitamin D intake from all sources Calcium: Women 50+ and Men 70+ need 1,200 mg daily. All else need 1,000 mg …