Teriparatide 

is a synthetic version of the human parathyroid hormone, which helps to

regulate calcium metabolism.
It promotes the growth of new bone, while other osteoporosis medications improve bone density by
inhibiting bone resorption, or breakdown.
In most regions, it is used as second-line osteoporosis treatment due to greater cost than first-line
agents such as alendronate.

Indications:

 Teriparatide has been reported to improve bone mineral density in other

clinical situations, such as osteogenesis imperfecta (brittle bone disease) and
anorexia, but it is not licenced for these indications.


SECOND LINE TREATMENT:

In women, this means that they must be unable to take alendronate or have an
unsatisfactory response to alendronate. Meaning;** (fracture or decrease in bone
mineral density despite being taking medication for 12 months)**

Also, women over 65 years must have a bone density T-score that is -4 or less or, -
3.5 and 3 or more fractures. Women under 65 years must have a T-score of -4 and 3
or more fractures.

When we find a poor response to alendronate, we start by ruling out poor adherence
and secondary osteoporosis **(such as vitamin D deficiency)** and then measure
bone turnover markers.

A T-score between −1 and −2.5 indicates that you have low bone mass, although not low enough to
be diagnosed with osteoporosis. A T-score of −2.5 or lower indicates that you have osteoporosis.
The greater the negative number, the more severe the osteoporosis.