There is an unknown but powerful agent that has the potential to give every person great bone health. This agent is teriparatide.
Teriparatide is a synthetic analog of parathyroid hormone (PTH), which is important for regulating plasma calcium levels and bone metabolism. Continuously high levels of PTH are catabolic to bone but intermittently high levels (e.g., when given once daily), have potent osteoanabolic effects. In fact, PTH-analogs are the most potent bone-building molecules currently available.
Given that bone mass degenerates with age, often leading to fractures that eventually result in inactivity and sarcopenia, it makes sense to boost bone mass using teriparatide at least once after a certain age (e.g., 50 years).
Obviously, with very few exceptions every women should be on HRT after menopause (topic for another day). However, this is often not enough.
People shrink with age and their spine is subject to microfractures, causing back pain and functional impairment. Furthermore, after a femoral neck fracture (which is by no means rare), all-cause mortality rises by 500-1000% (even higher in frail individuals with comorbidities) during the first year and often remains close to double for the rest of the person’s life. One in three women and one in five men will have a hip fracture after age 50. While not as bad as femoral neck fractures, they are still associated with a 40-50% increase in mortality over 5 years.
Furthermore, given that mobility will be somewhat impaired forever after fracture (as old people have a hard time regaining muscles) this leads to a huge impairment in quality of life, for example, a reduction in walks, less social interactions, and a lesser ability to exercise. Which then leads to all sorts of secondary and tertiary consequences.
I worked with a university osteologist before and I asked him what he would do himself if he himself had osteoporosis. His response: 1) Take teriparatide for 2 years. 2) Do a single infusion of zoledronic acid (or oral alendronate for a couple of months) after teriparatide treatment ends to prevent some bone loss as after teriparatide the bone is in a state of increased remodeling resulting in a rapid bone loss upon cessation of teriparatide (only for a few months and by far not enough to make up for the teriparatide gains) – bisphosphonates prevent this state of heightened remodeling/bone loss.
However, this should not be just reserved for osteoporotic folks but can (and in my opinion should!) be done by every person after age 50. If every person did this after hitting age 50 or 55 I am sure that we would slash fracture rate by a decent amount.
I know a couple of people who used it (including myself but to recover more quickly from labral surgery). Other than some lethargy after injection initially (just use it at night!) nobody had any side effects. What are the risks? A tiny uptick in osteosarcoma barely worth mentioning – particularly if people only use it for 2 years. In numbers, the Forteo Patient Registry tracked about 100.000 patients and found only 5 confirmed cases of osteosarcoma which is barely higher than the general population (about 3-4 per million).
Teriparatide is synergistic with weight bearing in the same way that anabolic steroids are synergistic with resistance exercise.
Given access to the drug, this is how one can get a decent uptick in bone mass for decades to come. There is preliminary research that teriparatide also helps a little bit with cartilage tissue as it is supposed to have chondroregenerative effects – particularly peri-injury.
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