Teriparatide (Forteo)
Overview
A recombinant form of the first 34 amino acids of human parathyroid hormone (PTH 1-34). When administered intermittently via daily subcutaneous injection, teriparatide stimulates osteoblastic bone formation more than osteoclastic resorption, producing a net anabolic effect on bone. It activates the PTH1 receptor on osteoblasts, increasing Wnt signaling, osteoblast differentiation, and survival while reducing sclerostin expression.
Key Research Findings
FDA-approved in 2002 for osteoporosis in postmenopausal women and men at high fracture risk. Fracture Prevention Trial showed 65% reduction in vertebral fractures and 53% reduction in nonvertebral fractures (Neer et al., NEJM, 2001). Treatment limited to 2 years due to theoretical osteosarcoma risk observed in rats at high doses, though no human cases have been attributed to teriparatide use.
Subcutaneous injection (daily)
FDA Approved
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Abaloparatide (Tymlos)
FDA ApprovedA synthetic 34-amino acid peptide analog of parathyroid hormone-related protein (PTHrP 1-34) that selectively activates the RG conformation of the PTH1 receptor. This receptor selectivity produces a more transient signaling response compared to teriparatide, favoring anabolic bone formation with less stimulation of bone resorption and calcium mobilization. Abaloparatide increases bone mineral density at both cortical and trabecular sites.
Calcitonin
FDA ApprovedA 32-amino acid peptide hormone naturally produced by parafollicular C-cells of the thyroid gland. Calcitonin inhibits osteoclast-mediated bone resorption by binding to calcitonin receptors on osteoclasts, reducing their activity and number. Salmon calcitonin is approximately 40-50 times more potent than human calcitonin and has a longer half-life, making it the preferred therapeutic form.
Vosoritide (Voxzogo)
FDA ApprovedA C-type natriuretic peptide (CNP) analog that acts as an agonist at the natriuretic peptide receptor B (NPR-B) on growth plate chondrocytes. Vosoritide counteracts the constitutively activated FGFR3 signaling that suppresses endochondral ossification in achondroplasia. By stimulating the NPR-B/cGMP/MAPK pathway, it antagonizes the growth-inhibitory FGFR3 signal and restores more normal linear bone growth.