RESEARCH = Calcium and vitamin D in patients on Forteo (teriparatide) for osteoporosis

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Calcium and vitamin D in patients on teriparatide for osteoporosis

Rheumawire

May 4, 2005

Zosia Chustecka

Cleveland, OH - In clinical practice, the doses for calcium and vitamin-D

supplements that are recommended by national guidelines for use in

osteoporosis may be too high for patients who are undergoing treatment with

the parathyroid hormone teriparatide (Forteo, Lilly) [1]. Having found

persistent hypercalcemia developing in several patients on this drug, Dr

Angelo Licata (Cleveland Clinic, OH) now limits the use of these supplements

and suggests that other physicians do likewise.

Writing in a letter in the May 5, 2005 issue of the New England Journal of

Medicine, Licata explains that when starting teriparatide therapy he now

maintains patients on daily elemental calcium at 1000 mg or less to keep the

serum level of calcium below 10 mg/dL and does not give supplemental vitamin

D at all if the basal level is greater than 20 ng/mL. " This approach may be

useful for practitioners as a way to prevent hypercalcemia in clinical

practice, " he says.

The recommendation is made after close surveillance of 12 patients, which

was prompted by a finding of persistent hypercalcemia (serum calcium levels

of 11-11.5 mg/dL) in 3 patients during initial use of teriparatide. In

addition to this drug, all 12 patients were taking calcium (mean daily dose

1100 mg), and 10 patients were also taking vitamin D (mean daily dose

355+200 IU). During the first 3 months of treatment, there was a decrease in

the levels of intact parathyroid hormone and in levels of 25-hydroxyvitamin

D and an increase in the levels of total serum calcium and

1,25-dihydroxyvitamin D.

The fact there was a substantial rise in serum 1,25-dihydroxyvitamin D

levels in the presence of decreased levels of intact parathyroid hormone and

increased levels of calcium suggests that teriparatide affects the serum

concentration of vitamin D even in the presence of physiological signals

that normally decrease its concentration, says Licata.

Licata has served as a clinical investigator for Lilly and NPS

Pharmaceuticals and has received lecturer fees from Lilly.

Source

1. Licata A. Osteoporosis, teriparatide, and dosing of

calcium and vitamin D. N Eng J Med 2005; 352:1930-1931.

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org