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JEFFREY STROUP, PHARM.D., BCPS, is Assistant Professor of Medicine, Oklahoma State University Center for Health Sciences, Tulsa. MICHAEL P. KANE, PHARM.D., FCCP, BCPS, is Professor, Albany College of Pharmacy, Albany, NY. ASIM M. ABU-BAKER, PHARM.D., is Assistant Professor, Wegmans School of Pharmacy, St. John Fisher College, Rochester, NY.

Address correspondence to Dr. Stroup at Internal Medicine, Oklahoma State University Center for Health Sciences, 635 West 11th Street, Tulsa, OK 74127.

Purpose. The efficacy, safety, and cost of teriparatide in the treatment of osteoporosis are reviewed. Summary. Osteoporosis is a leading cause of fractures in women and men but is underdiagnosed and undertreated. Antiresorptive therapies (calcitonin, estrogen, bisphosphonates, and selective estrogen-receptor modulators) have historically been used to treat this condition. Teriparatide (recombinant human parathyroid hormone) is an anabolic agent labeled for use in postmenopausal women and men with osteoporosis who are at high risk for fractures. Clinical trials indicate that teriparatide increases predominantly trabecular bone in the lumbar spine and femoral neck; it has less significant effects at cortical sites. The combination of teriparatide with antiresorptive agents is not more effective than teriparatide monotherapy. The most common adverse effects associated with teriparatide include injection-site pain, nausea, headaches, leg cramps, and dizziness. After a maximum of two years of teriparatide therapy, the drug should be discontinued and antiresorptive therapy begun to maintain bone mineral density. Teriparatide is expensive but may be cost-effective in selected patients. Conclusion. Teriparatide offers a therapeutic option for patients at high risk of an osteoporotic fracture and for patients who are intolerant of or unresponsive to antiresorptive therapy. Index terms: Costs; Fractures; Hormones; Mechanism of action; Osteoporosis; Postmenopause; Teriparatide; Toxicity