FORTEO® (teriparatide [rDNA origin] injection): Mechanism of Action

Detailed Information

Once-daily administration of teriparatide preferentially stimulates osteoblastic activity over osteoclastic activity, resulting in new bone formation.¹

New bone formation is observed on the trabecular and cortical (periosteal and/or endosteal) bone surfaces.¹

Structural histomorphometric analyses conducted on iliac crest biopsies from PMW with osteoporosis revealed that teriparatide improved

• trabecular bone volume

• trabecular bone connectivity

• structure model index, and

• cortical thickness.²

Dynamic histomorphometric analyses conducted on iliac crest biopsies from PMW with osteoporosis demonstrated that teriparatide stimulates bone formation on all bone envelopes (cancellous, endocortical, intracortical, and periosteal) as early as 3 months and remains sustained for the full 24 months of therapy.^3,4

Radionuclide bone scan imaging has demonstrated a direct metabolic effect of teriparatide on the whole skeleton and various subskeletal sites.⁵

New bone formed during teriparatide treatment has lower, more heterogeneous, mineral content, a property consistent with younger bone age.⁶

Enclosed Prescribing Information

FORTEO® (teriparatide [rDNA origin] injection), Lilly

References

The published references below are available by contacting 1-800-LillyRx (1-800-545-5979).

1. Forteo [package insert]. Indianapolis IN: Eli Lilly and Company; 2019.

2. Jiang Y, Zhao JJ, Mitlak BH, et al. Recombinant human parathyroid hormone (1-34) [teriparatide] improves both cortical and cancellous bone structure. J Bone Miner Res. 2003;18(11):1932-1941. https://doi.org/10.1359/jbmr.2003.18.11.1932

3. Dempster DW, Zhou H, Recker RR, et al. A longitudinal study of skeletal histomorphometry at 6 and 24 months across four bone envelopes in postmenopausal women with osteoporosis receiving teriparatide or zoledronic acid in the SHOTZ trial. J Bone Miner Res. 2016;31(7):1429-1439. http://dx.doi.org/10.1002/jbmr.2804

4. Dempster DW, Zhou H, Recker RR, et al. Differential effects of teriparatide and denosumab on intact PTH and bone formation indices: AVA osteoporosis study. J Clin Endocrinol Metab. 2016;101(4):1353-1363. http://dx.doi.org/10.1210/jc.2015-4181

5. Moore AE, Blake GM, Taylor KA, et al. Changes observed in radionuclide bone scans during and after teriparatide treatment for osteoporosis. Eur J Nucl Med Mol Imaging. 2012;39(2):326-336 http://dx.doi.org/10.1007/s00259-011-1974-y

6. Dempster DW, Roschger P, Misof BM, et al. Differential effects of teriparatide and zoledronic acid on bone mineralization density distribution at 6 and 24 months in the SHOTZ study. J Bone Miner Res. 2016;31(8):1527-1535. http://dx.doi.org/10.1002/jbmr.2825

Glossary

PMW = postmenopausal women