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What is parathyroid hormone treatment?

Parathyroid hormone (PTH) treatment is available as a colourless liquid which is given as a daily injection. There are two formulations of PTH currently available in the UK, Forsteo (Teriparatide) and Preotact PTH is a natural protein that is produced by the body to help in the regulation of calcium. When used as a daily subcutaneous injection, this treatment acts as a bone forming agent which is used to strengthen bones and reduce the risk of fractures (broken bones). It differs from other available treatments which work by suppressing the action of the osteoclasts which break down bone. PTH is the first treatment to renew the skeleton by stimulating the cells called osteoblasts which form new bone.


Who can take parathyroid hormone treatment?

Forsteo (Teriparatide) is currently licensed for post menopausal women and men who have established osteoporosis (low bone density as well as broken bones, bone density is the quantity of bone that, when measured, helps to indicate bone strength). Preotact is licensed for the treatment of post menopausal women. PTH treatment has been tested in people with severe osteoporosis, who have previously broken bones and so is most likely to be used in those with previous fractures in whom other treatments seem unsuitable. The treatment will initially be prescribed by hospital consultants with nursing support in the community because this treatment must be given by injection.

PTH treatment is more expensive than other treatments. Decisions regarding who may be suitable for this treatment may be affected by local, national and National Institute for Health and Clinical Excellence (NICE) guidelines.

PTH treatment cannot be taken if:

+You have had a previous allergic reaction to parathyroid hormone

+You have high blood calcium levels known as hypercalcaemia

+You have severe kidney or liver problems

+You have another bone disease e.g. Paget's diseas

+You have had radiation therapy to the skeleton

+You are pregnant or breast feeding (although only licensed for post menopausal use, occasionally it may be used by specialists in the younger woman)

+PTH treatment can only be used in adults


How is parathyroid hormone treatment taken?

Teriparatide (Forsteo) is supplied in a pre-filled syringe pen which is similar to a diabetic injection pen with a very fine needle. This pen will last for 28 days. Preotact is supplied in a cartridge which is then inserted into the Preotact pen which is again similar to a diabetic injection pen. Each cartridge is changed every 14 days. The treatment with PTH is given as a subcutaneous injection (just under the skin into the fatty layer) by the individual on a daily basis, preferably at the same time each day. The dosage is 20 micrograms of Teriparatide (Forsteo) or 100 micrograms of Preotact given daily as an injection into the thigh or tummy. Although Preotact is given in a higher dose, this is essentially equivalent in terms of strength to Teriparatide (Forsteo). People may be prescribed one pen / cartridge at a time or in multiple packs (this may depend on availability in some areas). If you are prescribed this treatment, you will need a healthcare professional such as a nurse to instruct you on how to use the pen injection.

PTH treatment needs to be stored in a refrigerator when not in use and a new needle is required for each injection. If it is difficult to access a refrigerator e.g. whilst travelling, Preotact can be stored for up to seven days outside of the fridge.

Maximum treatment with PTH is 18 months with Teriparatide (Forsteo) and 24 months with Preotact. Doctors have not yet clearly established through research whether it will be routinely necessary to begin other osteoporosis therapies to maintain bone health after PTH treatment has been stopped. There is evidence that fractures are reduced by 50% after stopping PTH treatment for at least another 18 months. Your consultant will assess you as an individual and advise accordingly.


Are there any side effects with parathyroid hormone treatment?

All drug treatments have side effects to a lesser or greater degree, although not everyone who has the treatment will experience them. The most commonly reported side effects in people using PTH treatment are nausea, limb pain, headache and dizziness

Changes in the levels of calcium in the blood and / or urine have been observed in patients commencing treatment with Preotact. It is therefore recommended that patients starting this treatment should have blood or urine tests after one, three and six months to monitor the level of calcium. No monitoring of calcium levels is required for Teriparatide (Forsteo).


Should I take any extra calcium with this treatment?

It is recommended that you obtain an adequate calcium intake as part of a well balanced diet. If you have difficulties obtaining adequate calcium from your diet, a calcium supplement may be prescribed by your doctor. It is worth noting, that all the people who were seen to benefit from parathyroid treatment in the clinical trials were also obtaining an adequate calcium intake.

Factors that can help to maintain healthy bones are a well balanced diet with adequate calcium rich foods, regular weight bearing exercise, avoiding smoking and keeping alcohol consumption within the recommended limits.

To obtain other NOS publications and Information Sheets, go to www.nos.org.uk or telephone 0808 800 0035.

To contact the NOS osteoporosis nurses, telephone the NOS Helpline on 0808 800 0035 or e-mail them on nurses@nos.org.uk

For regular updates on osteoporosis, join the NOS on-line today www.nos.org.uk

or telephone 01761 473117 / 473119 to speak to one of our Membership Co-ordinators.

The information given in this Information Sheet has been prepared in consultation with the NOS medical and scientific advisors as general guidance on the subject.