TERIFRAC (TERIPARATIDE) 750MCG INJ

Teriparatide is the only widely available anabolic (bone-building) medicine for osteoporosis. Unlike antiresorptive treatments (bisphosphonates, denosumab) that only slow bone loss, teriparatide actively stimulates new bone formation by mimicking the action of natural parathyroid hormone (PTH 1–34) on osteoblasts (bone-forming cells).

Intermittent low-dose PTH stimulates bone growth; continuous elevated PTH (as in hyperparathyroidism) actually breaks down bone — this is why once-daily injection dosing is critical.

Teriparatide is indicated for:

•       Severe postmenopausal osteoporosis with very high fracture risk (multiple vertebral fractures or very low T-score < -3.5, or fracture despite bisphosphonate therapy).

•       Osteoporosis in men at high fracture risk.

•       Glucocorticoid-induced osteoporosis (e.g. patients on long-term prednisolone) with high fracture risk.

Teriparatide is given by subcutaneous (SC) self-injection, once daily, into the thigh or abdomen. The recommended dose is 20 mcg per injection. The pre-filled pen delivers the correct dose automatically — press the injection button until the dose counter returns to zero.

Treatment duration: maximum 24 months (2 years) of total lifetime exposure. After completing teriparatide, an antiresorptive agent (bisphosphonate or denosumab) should be started to consolidate the new bone formed.

•       Digoxin: teriparatide-induced hypercalcaemia may increase sensitivity to digoxin toxicity — monitor calcium and digoxin levels.

•       Thiazide diuretics: additive hypercalcaemia risk — monitor serum calcium.

•       Calcium / vitamin D supplements: continue alongside teriparatide, but monitor calcium to avoid hypercalcaemia.

Store at 2–8°C (refrigerate). Do not freeze — freezing permanently damages the pen and the medicine. Keep the cap on when not in use to protect from light. After first use, each pen may be refrigerated for up to 28 days. Do not use after 28 days from first use or after the expiry date. Dispose of used pens safely via a sharps container.

Teriparatide is the most powerful medicine available for building new bone — clinical trial data show significant reductions in vertebral and non-vertebral fractures compared to placebo. It is the treatment of choice for patients with severe osteoporosis who are at very high fracture risk or who have failed bisphosphonate therapy.

Self-injection technique is straightforward and most patients adapt quickly. A nurse will teach you the injection technique before you start. If you experience significant dizziness after the first few injections, try injecting in the evening before bed.

After 24 months of teriparatide, it is essential to start an antiresorptive agent — without follow-up therapy, the bone density gains made with teriparatide are largely lost within 12–18 months.

Teriparatide pen devices vary by manufacturer — confirm the pen type and dose delivery mechanism at dispensing. The Forteo/Forsteo pen (Eli Lilly) delivers 20 mcg/80 mcL per dose; generic pens may differ in design. Coach patients on: refrigeration, injection technique, site rotation, and the importance of follow-on antiresorptive therapy.

Monitoring: serum calcium at baseline and after the first dose in high-risk patients; uric acid in gout-prone patients; renal function. The 24-month lifetime limit is strict — document the start date at first dispensing and track total treatment duration.

Switching from teriparatide to zoledronate or denosumab upon completion provides the most durable bone density preservation per current evidence.

What happens when I finish my 2-year course?

You must start an antiresorptive medicine (usually a bisphosphonate like alendronate, or denosumab, or zoledronate) straight away to preserve the bone density gains made. Stopping teriparatide without follow-on therapy means the new bone is reabsorbed.

Can I take calcium and vitamin D alongside teriparatide?

Yes — calcium (1000–1200 mg/day) and vitamin D (800–1000 IU/day) supplements are recommended alongside teriparatide. Your doctor may monitor your blood calcium levels to ensure you are not getting too much.

My injection pen feels warmer than expected — is it still OK to use?

If the pen has been left out of the refrigerator for more than 30 minutes before injecting, consult the product leaflet. Teriparatide that has been left at room temperature for extended periods or frozen should not be used.

How will I know if the treatment is working?

Your doctor will arrange a DEXA bone scan before starting and after completing the 24-month course to measure changes in bone mineral density. Clinical success is also judged by the absence of new fractures.