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This information is provided in response to your request. Resources may contain information about doses, uses, formulations and populations different from product labeling. See Prescribing Information above, if applicable.
Radiation-induced osteosarcoma is a rare, but well-recognized complication in human radiotherapy patients. Patients who have had prior radiation therapy have an increased risk of developing a radiogenic second malignant neoplasm, including osteosarcoma, some years or decades after initial treatment (Kalra, 2007; Newhauser, 2011).
Teriparatide should not be prescribed for patients who are at an increased baseline risk for osteosarcoma, including those who have had prior external beam or implant radiation therapy (Forteo Package Insert, 2012).
Examples of Prior Radiation Therapy Where Teriparatide Should Not Be Used
Therapeutic external beam radiation because most, if not all, likely impinges on some area of the skeleton (Data on file)
For example, patients who received radiation therapy for a soft tissue malignancy, such as breast cancer, likely have experienced radiation affecting the skeleton around the breast
Any type of radiation implanted into the body including
interstitial radiation, or
intracavitary radiation (Data on file)
Stereotactic radiation to the brain or other areas of the body (American Cancer Society, WWW)
Examples of Prior Radiation Therapy Where Teriparatide May Be Considered
Radioactive iodine therapy (Data on file)
Low doses of non-penetrative radiation, such as Grenz radiation, for treatment of skin conditions (Data on file)
Diagnostic radiation such as computed tomography scans, radiographs, and radionuclide scans (Data on file)
Non-radioactive forms of radiation such as ultraviolet radiation and phototherapy (Data on file)
Radiation During or After Teriparatide Therapy
There are no studies to describe the effect of teriparatide exposure on subsequent risk of osteosarcoma in patients that have radiation therapy after teriparatide exposure.
If a patient is receiving teriparatide and develops a need for radiation therapy, Eli Lilly and Company advises that the teriparatide treatment be discontinued immediately or prior to radiation therapy.
Enclosed Prescribing Information
The published references below are available by contacting 1-800-LillyRx (1-800-545-5979).
American Cancer Society. The science behind radiation therapy. Revised 2014. Available at: https://www.cancer.org/treatment/treatments-and-side-effects/treatment-types/radiation/external-beam-radiation-therapy.html
Data on file, Eli Lilly and Company and/or one of its subsidiaries.
Forteo [package insert]. Indianapolis, IN: Eli Lilly and Company; 2012.
Date of Last Review: March 23, 2018