Forteo alternatives: What can I take instead of Forteo?

Compare Forteo alternatives | Bisphosphonates | Bisphosphonate Combination Products  | SERMs | Denosumab | Romosozumab |  Natural alternatives | How to switch meds

Forteo (teriparatide) is a man-made form of parathyroid hormone, a naturally occurring hormone in your body. Historically, scientists viewed parathyroid hormone (PTH) as a catabolic agent, or an agent that helped to break down substances in the body. This holds true at high concentrations. However, several years ago, it was discovered that at intermittent, low doses, PTH actually serves anabolic functions, specifically with your bones.

Osteoporosis is a disease where bone quality decreases and you are at a high risk of fracture and bone damage. This could be because of a combination of a decrease in bone mineral density, osteopenia (low bone density), bone mass decreases, or bone structure changes. Unfortunately, you may not even know you have osteoporosis until your bones begin to break. Osteoporosis typically affects postmenopausal women and older men. It can also occur secondary to steroid use and gonadal failure. The fractures that occur are most common in the hips, vertebral spine, and wrists. Older adults are at an increased risk of falls which also makes these bone breaks more likely and even more dangerous.

Osteoporosis affects a significant number of adults in the United States. More than half of postmenopausal white women will have a fracture related to postmenopausal osteoporosis, and only about a third of those will be able to return to independent living. Obviously, there is a need for effective treatment for this disease. There have been effective long-term use agents on the market for several years now in other classes to reduce the risk of fractures. Forteo, however, is the only anabolic agent approved for osteoporosis treatment in the United States.

Forteo is a man-made copy of the first 34 amino acids of naturally occurring PTH. PTH is the primary regulator of calcium metabolism in the bone. Forteo increases serum calcium concentration like natural PTH does and stimulates bone formation by helping the body convert calcium into new bone. Given as a once-daily injection provides a transient increase in Forteo serum concentration and limits the negative effect of bone resorption you can see with longer exposure.

Forteo can cause hypercalcemia or high serum calcium concentrations. This can be very dangerous and is more likely to happen in those with a history of higher calcium levels. It has also rarely been linked to cases of osteosarcoma (cancer of the bone). It should be avoided in patients already at an increased risk of bone cancer, like those with Paget’s disease. High blood calcium levels, which might result in kidney stones, are another concern associated with Forteo. Instances of joint pain may also occur as a result of taking Forteo. There are other side effects like orthostatic hypotension (low blood pressure when rising or standing) that can occur. For this reason, it is best administered while the patient is sitting or lying down.

Fortunately, there are other treatment options for osteoporosis if Forteo isn’t right for you. Keep reading to find out more.

What can I take in place of Forteo?

Forteo may not be the right choice to treat osteoporosis in every patient. Fortunately, there are other treatment options. Forteo is the only parathyroid hormone product available in the U.S. The other treatment options for osteoporosis come from other drug classes. First and foremost, the over-the-counter supplements calcium and vitamin D are commonly suggested to help prevent osteoporosis or in patients who already suffer from osteoporosis. 

Bisphosphonates such as Fosamax (alendronate) and Actonel (risedronate) are highly effective oral treatment options for osteoporosis. In fact, recent guidelines published by The Journal of Endrinology and Metabolism lists bisphosphonates as first-line treatment in post-menopausal women. These drugs work by slowing down bone loss and preserving bone strength. 

Prolia (denosumab) is another subcutaneous injection that is a highly specific, human monoclonal antibody against receptor activator of nuclear factor kappa-beta ligand (RANKL). Prolia works by inhibiting osteoclast activation and decreasing bone resorption or bone breakdown. It only has to be given once every 6 months. Unfortunately, Prolia is not always covered by insurance plans, and it can be cost-prohibitive without coverage. 

Estrogen is an effective treatment to prevent fractures in post-menopausal women. Unfortunately, many women have contraindications to estrogen therapy. These include women with a personal or close family history of breast cancer, myocardial infarction (heart attack), and stroke. Evista (raloxifene) is a selective estrogen receptor modulator (SERM) that produces estrogen-like effects on bones and on lipid metabolism. However, it antagonizes the effects of estrogen on mammary tissue and does not stimulate the uterine tissue making it a safer alternative to estrogen. Evista is an oral, once-daily prescription drug treatment and is available generically as raloxifene.

This is not intended to serve as medical advice. You should speak to your specialist before stopping Forteo and consider all alternatives.

Other alternatives to Forteo

• Actonel with Calcium
• Calcitriol⟊
• Calcium + Vitamin D⟊
• Nandrolone decanoate⟊
• Sodium fluoride⟊
• Tamoxifen⟊

⟊Off-label, not approved by the FDA (Food and Drug Administration)

Top 5 Forteo alternatives

The following are some of the most common alternatives to Forteo.

1. Bisphosphonates

Bisphosphonates are considered by many to be a first-line treatment for osteoporosis. They are indicated in the treatment of osteoporosis in men, postmenopausal women, and corticosteroid-induced osteoporosis in men and women. They have once-daily, once-weekly, and once-monthly oral treatment options as well as a once-yearly IV infusion. Bisphosphonates inhibit the activity of osteoclasts, although osteoclasts are still activated, and reduce bone resorption. They do not directly affect bone formation. Most bisphosphonates are available generically now and are very cost-effective. Unfortunately, patients with esophageal and gastrointestinal diseases or those who can not stand or remain upright for at least 30 minutes may not be candidates for bisphosphonate therapy. Some of the common side effects of bisphosphonates are esophageal irritation and discomfort.

Examples: Fosamax (alendronate), Actonel (risedronate), Boniva (ibandronate), and Reclast (zoledronic acid)

2. Bisphosphonate Combination Products

In addition to prescription treatments, many healthcare providers will recommend calcium and/or vitamin D supplementation as essential elements for bone health. There are prescription products that combine bisphosphonates with one of these elements to promote supplementation.

Examples: Fosamax plus D (alendronate with vitamin D), Actonel with Calcium (risedronate with calcium carbonate)

3. Selective Estrogen Receptor Modulators (SERMs)

SERMs bind to estrogen receptors and activate estrogenic pathways in some tissues while blocking or antagonizing the estrogen pathways in other tissues. Like estrogen, SERM drugs reduce the resorption of bone while increasing bone mineral density (BMD). SERMs are only indicated for osteoporosis occurring in postmenopausal women. It is not indicated in men or other osteoporosis types. Because of the selective action of SERMs on estrogen receptors in particular tissues, they are safer to take in women with significant medical history for things such as heart disease, stroke, or breast cancer. SERMs are once-daily oral prescription drugs.

Example: Evista (raloxifene)

4. RANKL Human Monoclonal Antibody

Denosumab is a subcutaneous injection that is a highly specific, human monoclonal antibody against receptor activator of nuclear factor kappa-beta ligand (RANKL). It is indicated in the treatment of osteoporosis in men, postmenopausal women, and corticosteroid-induced osteoporosis in men and women. It works by inhibiting osteoclast activation and decreasing bone resorption or bone breakdown. It only has to be given as a 60 mg injection once every 6 months. Denosumab can cause a sometimes fatal case of hypocalcemia, or low blood calcium. Calcium levels should be monitored frequently.

Example: Prolia (denosumab)

5. Humanized IgG2 Monoclonal Antibody

Romosozumab is unique in its dual mechanism of both increasing bone formation while decreasing bone resorption. It is only indicated for women who have gone through menopause and are at high risk for fracture. It is not indicated in men or osteoporosis caused by other factors. This drug is given once monthly for 12 months and then is typically discontinued. This is generally considered only once fractures have occurred despite other treatment options, including oral therapy. It is contraindicated in patients with a recent history of heart attack or stroke.

Example: Evenity (romosozumab)

Natural alternatives to Forteo

There are many nutrition and lifestyle choices to prioritize in order to decrease the chances of developing osteoporosis. Getting plenty of fruits and vegetables in your diet is important. Calcium, vitamin D, and protein are essential to healthy bones. These can be found in dark green, leafy vegetables, salmon, and dairy products. As you get older, it is important to balance these needs with calorie consumption. Refer to the National Institutes of Health osteoporosis diagnosis chart to get your recommended daily intake of calcium and vitamin D. While vitamin D will not reverse your osteoporosis, it is necessary for the absorption of calcium.

You should avoid smoking and secondhand smoke exposure. Exercise, specifically weight-bearing exercise in your younger years, helps build bone mass and is critical to the health of your bones well into your older years. As you get older, consistent, low-intensity exercise is important to continue.

How to switch to a Forteo alternative

The root cause of your osteoporosis and a few other factors determine how many alternatives to Forteo are available to you for the treatment of osteoporosis. If you are on Forteo, you may have already been on some of the alternatives, so be sure to talk to your doctor about your complete medical history first when considering an alternative. If cost is a factor that concerns you, your insurance company or pharmacist can help answer questions about your coverage. You can also visit SingleCare to find the lowest prices on medications without insurance.