Pharmaceutical companies are constantly trying to outdo each other and to come up with new patentable drugs for diseases that already have existing drug treatments.. A good example of this is teriparatide, or Forteo in the US (Forsteo abroad), a new class of osteoporosis drug known as anabolic agents. This daily injectable drug was approved by the FDA in 2002.
Forteo is an incomplete synthetic or man-made form of the human parathyroid hormone (PTH). You see, human PTH has 84 amino acid residues but teriparatide has only 34. Teriparatide has become the osteoporosis drug of choice mainly for patients who can’t tolerate bisphosphonates, have failed to improve with bisphosphonate therapy, or suffer from extreme bone loss.
As touted on the drug’s insert, Forteo “increases bone mineral density and bone strength.”
Many unanswered questions
But the puzzling catch with Forteo is that the way in which it works remains a mystery. This is openly acknowledged by its maker, pharmaceutical giant Eli Lilly and Company. The drug’s brochure states that “the role of PTH in control of bone mass is still not really understood” and that “intermittent spikes of PTH, such as given by daily injection, will cause more increase in bone formation than in bone resorption… This has been shown in rats.”
Unfortunately, what has also been shown in rats is the development of osteosarcoma, a lethal bone cancer caused by an abnormal proliferation of osteoblasts or bone-forming cells. Below, I quote again from Eli Lilly’s pamphlet (https://pi.lilly.com/us/forteo-medguide.pdf):
“During the drug testing process, the medicine in Forteo caused some rats to develop a bone cancer called osteosarcoma. In people, osteosarcoma is a serious but rare cancer. Osteosarcoma has been reported rarely in people who took Forteo. It is not known if people who take Forteo have a higher chance of getting osteosarcoma.”
Because of this serious side effect risk, Forteo is prescribed for a maximum of two years. This is as close as one can get to playing Russian roulette! Who would trade a potential fracture for the awful risk of acquiring a lethal cancer? And as if this were not enough, teriparatide has a long list of nasty side effects such as joint and chest pain, muscle pain and weakness, esophageal problems, nausea, and vomiting. Plus having to inject oneself subcutaneously each and every day is most certainly no picnic.
Exorbitant price tag leads to exorbitant profits
The unanswered questions don’t seem to hamper Forteo’s skyrocketing success. According to drug-industry analysts, an estimated 600,000 prescriptions were written in 2005, which generated more than $350 million in revenue. And in 2008, Eli Lilly reported $778 million in sales. (https://newsroom.lilly.com/ReleaseDetail.cfm?releaseid=362195).
Indeed, the future looks bright for Forteo. As predicted by Pharmacor’s June 2009 osteoporosis report, by 2018 Forteo sales may reach close to the $2 billion mark.
One easy way to explain these numbers is Forteo’s exorbitant price tag. It costs nearly eight times as much as bisphosphonates, running up a tab of about $6,700 a year. That’s a pretty high cost for a drug whose mechanism is not even remotely understood!
Doctors ignore ignorance?
Another puzzling aspect of this drug is that while doctors openly admit their ignorance regarding how it works, they choose to prescribe it anyway.
Dr. Roberto Pacifici, head of the division of endocrinology at Emory University School of Medicine, comments that “…how intermittent treatment (with teriparatide) works has remained a mystery”. (https://whsc.emory.edu/home/news/releases/2009/09/bone-building-hormone.html).
This is clearly a rather unusual and perplexing situation to say the least.
And it sounds like a job for Agent 4T0…
Mission: Impossible
Remember the TV series with this name? I used to be a big fan of Mission: Impossible. Each episode began with secret recorded instructions to the brave agents describing a very complex and often dangerous mission. The agents could decide whether to accept the mission or not. Of course, the fearless members of the Impossible Mission Force (IMF) never walked away and in the end, always succeeded. But here's what happens when a reluctant osteoporosis drug is the agent chosen for the mission… Read my Mission: Impossible spoof below:
“Good morning, Mr. Paratide. Your mission, should you decide to accept it, comes from the top boss, Big P.”
“You can call me Terry… What is my mission?”
“First, from now on your new name is Agent 4T0. Your mission is to strengthen this patient's bones and report back to us detailing exactly what you did. And you have to report back to us fast, 4T0. Time is running out.”
“Well, I may be able to strengthen the bones, but I have no idea of what I'm doing! Big P knows that we've been trying to find out without success. I need written instructions!”
“You’re the ACTIVE INGREDIENT, for crying out loud! Plus Big P has given you a team of helpers…”
“What… you mean the Inactive Ingredients? I don’t see how glacial acetic acid, sodium acetate, mannitol, metacresol, and hydrochloric acid can help me. They’re INACTIVE, remember?”
“Stop acting like a coward, 4T0. Here’s a little secret for you: metacresol is highly flammable and poisonous – even lethal in the right dose. It can help you solve this mystery if anyone gets in your way. So get creative and solve it once and for all.”
“I’m not a fighter! I’m just a synthetic wannabe, I don’t know what to say…”
“Remember our motto: Ignorance is Strength. You don’t have to know anything… nobody has to know anything… that’s our strength, 4T0. Big P’s survival depends on ignorance. Just invent something and Big P will make sure that everyone will take our word for it.”
“Yes, I know that's the way we've been operating in the past, but now people are waking up real fast…Why me, why me?”
“This tape will self-destruct in five seconds.”
“Oh, nooooooo!”
So there you have it.
Were you prescribed Forteo? Even if you weren't, please share your experiences, thoughts, and comments with the community below.
Having suffered broken L3 & L5 vertebrae within 5 months when 67 I was prescribed Forteo. I self-injected each day for 16 months. Well into my treatment Vitamin D was discussed and I commenced 5000 units/day. At the end of treatment I was prescribed Prolia by my rheumatologist. My bone density tests showed great improvement and after discussion with my primary care physician I chose not to take Prolia. The results of my next annual bone density test with respect to Prolia or alternative Rx will be discussed to ensure bone health. Meanwhile, I continue to take 5000 units of Vitamin D.
Additionally, I have a preliminary diagnosis by JHopkins & VA Cancer Specialists of CML or CMML. No link to Forteo has been mentioned.
I just finished my 2 year forteo. According to my doctor i had ABSOLUTELY NO IMPROVEMENT!!! Has anyone else had this result? (I don’t understand lab numbers). I am breaking bones.
Two months ago I finished the 2-year Forteo treatment. Although I Experienced some bi vertigo when taking it, and for that reason always did it in the evening, I otherwise had great results in terms of building bone mass and feeling strong, much stronger. Now I have a dilemma! I have normally never taken drugs ever. Always the natural treatment path. Now I am being told that if I don’t take Fosamax or Reclast, I will lose all that I gained! I believe that Fosamax would be too hard on my digestive tract and I believe that Reclast would be too hard on my kidneys. So now I don’t know what to do. I feel great, but I’m being told that I will lose all that I gained if I don’t take one of the drugs. Does anyone have any experience of doing the two-year treatment and then not continuing with another drug therapy? Did you lose all that you gained?
Joanna
I’m in the same boat. Ready to stop Forteo abruptly but can’t find studies that tell me if it is safe. Did you get an answer to your question? What did you do?
Hi Joanna!
I’m almost finish the 2 year treatment too. I have been told the same. What did you did?
It’s kind of frustrating…
I had terrible side effects like cramping, dizzying, pain in all my bones.. what it helped a little was a weighted blanket when I go to sleep. It calms a little the sensation of cramping and pain.
The medication also raised my alkaline phosphatase and uric acid.
I’m glad its almost the end. At least, my bone density has improved a lot.
I’ve been on Forteo for 20 months now. Just wanted others to know I am a 60 yr old female with several previous fractures so my dr put me on Forteo. I have had NO SIDE EFFECTS! The shots are easy, since the mini-needles are so tiny you don’t even feel them. There seems to be 99% horror stories about Forteo on this site so I thought I’d share my positive experience thus far. Haven’t had a DEXA scan yet, won’t know results until my 2 yrs are up but I am happy to be on this drug in case it works well for me 🙂 I don’t understand all the negative reviews…my dr told me the first several weeks you would probably experience some “growing pains” in bone as your body adjusts to the increase in calcium. Had very slight growing pains at first but subsided by 6 weeks. No problems with it!
I have been on Forteo for 23 days. Thank you for sharing your experience! I’ve searched to see if any one had suffered growth pains.
I think that may be what I am feeling. Could be a good indicator that it is working.??
I have also noticed mood/mental confusion. I am hoping that this will improve as my body adjusts to Forteo.
With no other significant treatment available, I am afraid to stop trying this.
I am 61 and hope to improve and enjoy my life again.
Thanks again!
Sherry
Ana (Sept 11 2018,, Perhaps you should consider
https://americanbonehealth.org/bonesense/why-strontium-is-not-good-for-bone-health/
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I have been on Forteo for 13 months and my lumbar bone density increased 5.2%. My hips worsened by 3.4%. At the time I was recovering from a shattered shoulder and had reverse shoulder replacement. I am early 60s. I use bi-est cream and progesterone cream and take 100 micrograms levoxyl daily . When I first started injecting Forteo, I lost energy and became disinterested in life. I use caffeine but found that when I added testosterone cream in small amounts, I felt more normal. I am also dizzier. I exercise my lower body a lot and do vigorous walking 5 to 6 days a week. 2.5 miles up a big hill and down. I only started my lower body exercise the last 6 months. I have jumping exercises that I am only starting to get back to and feel that having neglected that for most of last year may account for the hip density loss. I am also doing a med ex back machine and Roman Chair exercise which I think increases back muscle and maybe glute muscle tension. Stronger muscles are thought to exert a tension on bones that favors bone formation.
I found your comments interesting especially since I have a very damaged shoulder with my surgeon recommending total reverse shoulder replacement. I on have been on Forteo for 2.5 months, and an elderly man of 83 and have experienced daily pain from an auto collision 43 years ago. At the end of July in simply twisting in a standing position received a compression fracture of T-11 and before I could get a Kyphoplasty injection the vertebra collapsed 80% and a bone scan revealed severe oteoporosis. Since my forteo injections I have been experiencing more severe nightly pain and stiffness, in new places such as in my replaced knees. Waking in mid night I am in severe pain with any mov
ement, greater than in the past 43 years of daily pain. Of course I am in a quandry as to losing he bone-building benefit of forteo vs quite an increase in whole body pain.
I’ve only taken Forteo for 23 days and bone pain has been the biggest symptom. I am hoping it is an indicator of bone growth as it feels similar to that I experienced as a child.
I hope that you do well!
I’m a 48 year old female with RA. I’ve been on prednisone for over 10 years for my RA. I was diagnosed with osteoporosis when I was 36 after a wrist fracture. In the last two years I’ve fractured 2 ribs and recently am recovering from several spontaneous fractures in my pelvis ( 6 total). Spent the whole summer on total bed rest. I still have young children at home and one with a disability. I’ve tried recast, proliea? and I started Forteo about a month ago. My biggest concern is the risk of cancer. I’m already on immune suppressants due to RA. I take Xeltranz, used to take Rituxian. I wasn’t given much of a choice about Forteo the doctor said my bones were so bad I had to start it. All my fractures were w/no trama. I want to be alive and have a good quality of life long enough to see my children get married etc. Worried most about long term effects.
M Anderson. The studies that cover 10 years 2009-2019 show no patient registered ( there is a Forteo registry since 2009) matches the list of people diagnosed with osteosarcoma. Even if there are a few, it doesn’t mean it was caused by Forteo. All medications have risks and benefits. I would think your risk would be very high of an adverse long term complication from breaking a bone with your history. Please don’t worry about a “possible” risk and one that so far has not shown to be substantial in humans. I do prescribe Forteo in my practice and have been very happy with my patients outcomes…. because they are also happy with the improvements. I get no money and any compensation from prescribing Forteo. I am just a regular Nurse Practitioner trying to help patients with pain from frequent fractures.
While I realize that Forteo can have nasty side effects, I thought people researching that drug should know about me. I have been taking Forteo injections for 15 months and have suffered no side effects at all. What’s more my chronic problem with severe back pain has vanished, presumably because some kind of fracture that was causing the pain has now been filled in. I could not be happier with Forteo and I thought those of you who are still thinking about taking it should know. Too often the only people who speak out are people who have had bad experiences. I realize that no two cases are the same and that nasty side effects are possible. In fact, I too could have nasty side effects eventually. But so far, Forteo has been a miracle drug for me. By the way, before I started taking that drug I got a consultation/second opinion from a leading osteoporosis doctor at a major medical center. He concurred with my local doctor and shortly thereafter I began taking Forteo.
I have just been recommended to take FORTEO and am wondering if it is safe enough after reading some of the reports of some of the people. Yours seems to be a positve one. I am also concerned about giving myself the shots as my skin is kind of sensitive. (and I don’t like needles)
The needles are TINY. You really don’t feel it at all! The hardest part is travelling with the drug because you have to keep it cool. I used cool gel packs in a Yeti water bottle. Has worked just fine.
I was on Forteo for 2 years and continued to have fractures while on it. My bone density did improve and Forteo is the only med that actually helps grow new bone unlike Bisphosphonates which actually prevent the formation of new bone and basically makes your body keep old brittle bone it would normally get rid of. Sure your DEXA scans show increased bone density but the bone is old brittle bone that is normally discarded. Even after Forteo my bone density increase was temporary and not worth it in my opinion. My teeth started breaking off when taking Forteo and I had perfect teeth my whole life. I wound up having to get them extracted they were so destroyed and will be getting dentures. I became a vegetarian and started following the save our bones program loosely as well as taking a veal bone supplement called Boisil. I put my life at risk and lost all my teeth for about 8 months of increased bone density and even suffered compression fractures while on the medication. My Dr prescribed Prolia after Forteo and after two shots (one every 6 months of Prolia) I had done enough research to say no more. I wish I had known what I know now about Osteoporosis when I first got it. Watch some seminars by holistic Dr’s on youtube regarding Osteoporosis and do all the research you can because just sitting back and letting some Dr. make some of the most important decisions of your life is NOT the way to go.
I am so sorry to hear of all your struggles and suffering. I have been prescribed fosamax, boniva, forteo, prolia, in addition to taking some hormones — estrogen alone, then with progesterone…..I take strontium citrate now 2 hrs after final dinner meal, then magnesium upon morning awakening, then 2 hrs later calcium with d3 and k2 with mq7 with some food, then at least 1 hr later a multi with some food. I am hopeful this will eventually [once the after effects of those pharma nasty drugs dissipate] naturally strengthen my bones. I have no side effects and it costs less that $10 per month. Strontium [not ranelate] was used to strengthen bone and teeth from 1850 to 1955 until big pharma decided they could not patent a natural element. So, they started trying to synthesize something to equal or replace it — and they still are. The best thing to do is read up on strontium citrate [not strontium ranelate a synthetic created in Europe.
I just discovered they should not use forteo with or within 2 years of using any bisphosphanate or it will cause fractures. They don’t tell you that. Prolia will cause rebound fractures when you discontinue it and neither will build bone as quickly as Strontium citrate. They will say there are no studies for strontium citrate but the proof is those who take it STOP HAVING FRACTURES. I have never fallen or had a traumatic fracture. I have spontaneous fractures–just drying my hair or turning on the sink or taking a shower or picking up my cellphone. These are caused by the BAD DRUGS especially in combination with one another. I do have a family history but even my mother who hardly ate and drank 8 oz of vodka daily didn’t have spontaneous fractures….she had to have trauma to break a bone.
I am 71 and aside from breaking L3 10 years ago lifting an awkward box did not fracture again until 2 years ago when 11 spontaneous fractures just kept happening.
I hope you will read up and investigate and come up with a plan to try the natural treatment with strontium citrate. I don’t think it will hurt you at all and certainly will be kinder to your poor tortured bones and body. If I come up with the ideal protocol I will post it here when I do. We can all help one another much more quickly and efficiently than the doctors are willing or able to do. It’s up to us to help and heal ourselves.
You should read this related article.
https://americanbonehealth.org/bonesense/why-strontium-is-not-good-for-bone-health/
Hi. Thank you for this information. I really appreciate it. Im 59 & just completed two years of Forteo. Ive never taken a Boniva-type drug but they want me too. Im scared of jaw necrosis (Ive always had jaw issues). Anyhow, I was a little confused About fractures. I hope my Forteo treatment will not cause this. I am going to research strontium citrate now! Any other natural remedies that have helped? Please forward. My Doc says I will start losing bone & go right back to Osteoporosis if I don’t take a biophosphate (Boniva, reclast). She wants me to do a one year IV of reclast. Thanks again.
Ana,
Have you considered:
https://americanbonehealth.org/bonesense/why-strontium-is-not-good-for-bone-health/
Regards – Paul