What are the contraindications for use of teriparatide (Forteo) in the treatment of osteoporosis?

Updated: Jan 20, 2021
  • Author: Rachel Elizabeth Whitaker Elam, MD, MSc; Chief Editor: Herbert S Diamond, MD  more...
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Answer

Before treatment with teriparatide, levels of serum calcium, PTH, and 25(OH)D need to be monitored. Teriparatide cannot be given for more than 2 years total in a lifetime due to concerns for increased risk of osteosarcoma; higher incidence of osteosarcoma was seen with high doses in animal studies. However, evidence to show an increased risk of osteosarcoma in humans receiving therapeutic doses of teriparatide has not been obtained. [171]  Contraindications include the following:

  • Pre-existing hypercalcemia
  • Severe renal impairment
  • Pregnancy
  • Breast-feeding mothers
  • History of bone metastases or skeletal malignancies
  • Increased baseline risk for osteosarcoma, including but not limited to Paget disease, unexplained elevated alkaline phosphatase level, or prior external beam or implant radiation therapy
  • Children and young adults with open epiphyses or prior radiotherapy of the skeleton [172]

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