When is anabolic therapy such as teriparatide considered?

• A. In patients as first-line therapy for all.
• B. In patients at very high fracture risk or who fail or cannot tolerate antiresorptives; typically limited duration up to 2 years.
• C. For patients with osteoarthritis.
• D. For patients with low calcium only.

Answer: (B)

Anabolic therapy with teriparatide is considered for patients who are at very high fracture risk or who have failed or cannot tolerate antiresorptive medications. These agents actively stimulate bone formation, leading to faster gains in bone mineral density and a meaningful reduction in fracture risk compared with many antiresorptives. Because of safety data and practical treatment plans, this therapy is used for a finite period, typically up to about two years, after which the patient generally transitions to an antiresorptive to maintain the gains achieved during the anabolic phase.

This isn’t used as first-line therapy for everyone, since most patients with osteoporosis are started on antiresorptives, and it isn’t indicated for conditions like osteoarthritis or simply low calcium. Teriparatide specifically targets bone formation and is reserved for those with the greatest need or who cannot tolerate other options.