Therapies which stimulate bone formation

Therapies which stimulate bone formation include:

• calcium and vitamin D supplements
• calcitriol

Teriparatide is the first parathyroid hormone derivative to be licensed for the treatment of women with postmenopausal osteoporosis and stimulates bone formation.

• it is a recombinant peptide identical to the active 34-amino-acid sequence of endogenous parathyroid hormone (which is an 84-amino-acid peptide)
• recommended for use in postmenopausal women with severe bone loss, men with osteoporosis who have a high risk of fractures, and persons who have not improved on bisphosphonate therapy (1)
• a review concluded (2) "..On published evidence, we can see no convincing reason to use teriparatide in preference to older treatments for women with postmenopausal osteoporosis."
• contraindicated in patients with risk of osteosarcoma, such as those with Paget disease, previous skeletal radiation, or unexplained elevation of alkaline phosphatase level (1)

Some evidence suggests that fluorides and anabolic steroids may have a role, but this is far from established.
Notes:

• there is evidence that human parathyroid hormone significantly increases BMD at all skeletal sites except the radius and significantly reduces the risk of new vertebral and nonvertebral fractures in postmenopausal women with prior fracture (3)
• a study has suggested that teriparatide therapy should be followed by bisphosphonate therapy in order to maintain BMD gained (1)

Reference:

• (1) Sweet MG et al. Diagnosis and treatment of osteoporosis. Am Fam Physician. 2009;79(3):193-200
• (2) Drug and Therapeutics Bulletin (2004); 42(12): 93-96
• (3) Cranney A et al. Parathyroid hormone for the treatment of osteoporosis: a systematic review. CMAJ. 2006 Jul 4;175(1):52-9.