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Is Forteo™ a new bone wonder drug? Not really!

Forteo™ is promoted as a rising star on the osteoporosis scene, a bone drug that actually builds new bone, rather than just halting bone loss. By various mechanisms, Forteo “tricks” the body into building substantial new bone mass and short-term studies show Forteo actually reduces fracture more than other bone drugs. Sure, it is very expensive and has to be given by daily self-administered injections, but still, the large bone density increases and unprecedented reduction of both spinal and hip fractures are impressive.

While all this sounds great, when we look more carefully, we see Forteo has a variety of serious drawbacks and side effects. First, it is experimental and poorly tested. It also brings with it a series of potential adverse effects. These adverse effects include the development of bone cancer in animals, the potential to cause excessive new bone formation, high blood calcium, nausea, immunologic responses, leg cramps, hypotension, depression, and dizziness. For these reasons (not to mention its expense), I do not think Forteo is a worthwhile option for the treatment of osteoporosis in the majority of patients.

To read my full analysis of the Forteo drug, see my article Forteo™ – is this bone drug too good to be true?.

 

We created the Osteo Blast blog as our forum to express opinions and educate the public about natural means of supporting and improving bone health and overall wellness. As part of this forum, we sometimes discuss medical issues and medications, and their effects on bone health in general. However, we cannot advise readers about specific medical issues in this forum. If you wish to obtain advice from Susan E. Brown, PhD, about your specific bone health and nutritional concerns, please visit our Consultations page. Other specific medical questions should be referred to your healthcare provider.

Comments

June 30. 2009 16:09

Calcium Hydroxyapatite also works to build bones.  Also it's important to eat loads of greens, raw in salads and green smoothies, lightly steamed and quickly stirfried (in coconut oil -- has a higher smoke point than olive oil).  Loads of greens is not a dosage amount so I would suggest a daily 2 c. salad with as dark a green as you can find (not iceberg lettuce)or 2 c. of an organic salad mix and a 1/2-1c. serving of a dark green veggie like broccoli, Swiss chard (tastes like spinach but more delicious), kale, broccoli rabe (saute with garlic, fresh lemon juice, hot pepper flakes and coconut oil, and salt and pepper to taste -- yummy)!

Suz

June 30. 2009 16:29

Thank you so much for this information on the latest "miracle drug."  Too many people take Rx without knowing all of the side effects.  In effect, many are just human guinea pigs. It is nice to have an update from an expert in the field!

Carol B. Blair

July 1. 2009 13:26

How does Dr. Brown feel about Strontium Citrate?

Triena

July 1. 2009 15:58

Hi, thanks for the email re Forsteo, I was contemplating starting taking it but after reading this I have changed my mind. Its very worrying, I wish I had been told all this when I saw  my endo. I am in the UK and dont really know what to do now!

daphne hopwood

July 1. 2009 22:52

I have very severe osteoporosis from childhood kidney disease. I'm 52 now, but it started in my 20s. Last year, I broke 3 bones in my pelvis and five vertebrae! I'm 4.5 inches shorter than when I graduated from high school. My endocrinologist started me on Forteo in Feb 2008. After a full year, he checked my bone density. It was much WORSE.  Not better. At least on Actonel, I was fairly stable, though not improving. Now I'm showing drastic loss again. Of course, I also just now became menopausal. My renal calcium leak has worsened, too, so I'm not sure we can blame it on the Forteo. Needless to say, I'm not using that medication any longer.

Deb Stover

July 2. 2009 03:25

I find it hard to beleive that any drug chemically manufactured can improve/cure a condition such as osteoporosis. What we tend to ignore when looking at our illness is that we at some time in our existence created the potentials to have this illness and even if a cure was invented it may not necessarily work on everyone. The mind plays a more powerful part in what we experience in this life than we think.Perhaps we need to purify the mind.

linda brown

July 3. 2009 15:45

Dear Dr. Brown -
I wouldn't take Forteo for anything. The most common side effect is tachycardia, and I am already prone to supra-ventricular tachycardia episodes. I don't want Atrial Fibrillation.

Also, I have secondary hyper-parathyroidism because I am 62 and my body no long makes vitamin D, even if I walk in the sunshine every day. Right now, my parathyroid hormone levels and vitamin D levels are normal and mid-range, from taking high doses of calcium (and magnesium and manganese, of course) and vitamin D, as suggested by my bone density doctor, Dr. Murray Favus at University of Chicago.

Dr. Favus heads the Bone Density and Endocrinology clinic and is a parathyroid specialist. I am fortunate to have found him a few years ago.  

I use Calcitonin nasal spray (Sandoz generic works even better for me than the brand name Miacalcin), and unless a person really has a problem with the peptide it contains (lab-produced but supposedly bio-identical to one from salmon), it isn't likely to have the risks of other bone density Rx medications.

Vitamin D3 suppresses excess production of parathyroid hormone, so if a person's skin/body no longer makes the vitamin D, the vitamin depletion can lead to abnormally high levels of parathyroid hormone, which can leach bone/minerals and cause a decrease in bone density.

Primary hyper-parathyroidism can, due to a fatty tumor or tumor or cyst, can suddenly cause kidney stones, gallstones, and a heart attack. My late sister (died of other causes) had that from two benign parathyroid tumors, about 25 years ago.

Twinlab Tri-Boron Plus does contain some vitamin D, but not enough for me. It is the bone density supplement used by the largest  percentage of us Celiac Disease people (gluten intolerance, autoimmune disorder, malabsorption disorder)who subscribe to a specific discussion/email list online.

Also, I started taking Ipriflavone, soy Genistein (in soy isoflavones), and the MK4 form of vitamin K2 (Methatetrenone)after reading a research report about the MK-4 form of K2 working as well as bone density medications.

After just 3 months of adding the Ipriflavone, Genistein, and Methatetrenone to my regime, a DEXA showed my hips had increased in bone density, and my lumbar spine - which had decreased after prolotherapy injections to an adjacent area to form scar tissue to stabilize a sacroiliac joint- had increased slightly.

I lost two years' gain in the lumbar bone density because of those prolotherapy injections and won't go back to the orthopedist. The chemical injections (prolotherapy, but not a sugar solution) apparently made my Osteoclasts in the area go wild.

I later had physical therapy and learned to build core strength (central abdominals and external obliques) to stabilize my  problematic sacroiliac joints.

Hopefully I will eventually be out of Osteopenia range and into low normal in the future.

Yours truly,

Vicki E. Jones, RYT (a yoga teacher designation, and I specialize in teaching safer yoga for Seniors, designed to help strength, range of motion, balance, and bone)
Homewood, IL

Vicki E. Jones

July 20. 2009 10:30

Triena,

Small dietary amounts (1-10 mgs) of stronitum are important to bone health.  High dose strontium (like 680 mgs)is a pharmacological treatment for osteoporosis used in France and other parts of Europe.
Soon I will write a full article on the topic.

Dr. Susan Brown

July 23. 2009 11:29

Hi Trina,

Strontium is found in the diet in few milligram levels and is a bone-building nutrient.  High dose strontium (say 700 mgs) is used as a bone drug in Europe and helps build bone density while reducing fracture.  It is , however, a high dose drug therapy and like all drugs has the capabiity of imbalancing the body.

Dr. Susan Brown

October 6. 2009 17:17

I have found Strontium in a natural foods grocery store in a dose of 680 mg.  It is part of a total formula for rebuilding bone.  I understand this is a high dose--what are the possible side effects of taking this much?

Sharon

October 16. 2009 14:30

Dear Sharon,

Strontium is a mineral that is found in low doses in food and water. An average strontium would be a few mgs a day. A synthetic form of strontium (strontium renalate) is used in Europe as a drug for osteoporosis. It is used in very high doses of something like 680 mgs elemental strontium. In the US high-dose strontium is sold as a supplement in the form of strontium carbonate or strontium citrate. In doses of several hundred milligrams strontium is a pharmacological agent, not the nutritional substance.  As with all high-dose pharmacological agents is unnatural to the body and likely places certain stresses and strains on our body systems. In the case of high-dose strontium kidney has to deal with everything excesses. The European researchers who work with the strontium drug say is very safe and one of the few side effects I have seen reported concerns rare cases of thrombosis or clotting in high-dose strontium use.  Strontium has only been on the market for a few years,so you might want to keep your eye on the research and see what the findings are as to side effects As time goes by.  Also remember that high dose strontium is not natural and thus not part of the Better Bones Better Body approach. If you need osteoporosis drug therapy, however, I suspect it is safer and has less side effects than many of the American bone drugs.

Susan Brown

Susan Brown

May 1. 2010 20:23

What do you think about machines that "jiggle" a person? (think of the old belly buster machines of the '70's) I read about something like this in my Nursing magazine as an alternative to drugs for osteoporosis treatment.

Michelle Clifton

May 4. 2010 13:24

Hi Michelle,
After many years of looking at the data on whole body vibration, "jiggling" as you call it, I am convinced that this type of exercise can greatly enhance both bone and muscle strength.  We are currently experimenting with one such device and would be happy to e-mail you a packet of material on the topic.  Just e-mail betterbones.maryjo@verizon.net asking for the WBC packet.  Keep posted as we will soon be writing more on WBV.  Good luck, Susan

Susan Brown

May 13. 2010 15:00

Wow. This is such terrible advice and not just a disservice but likely harmful. There is one person on this forum who has already stated they will not use Forteo based on this advice.

The studies of rats was at exceptionally high doses for two years. That is in an animal with a 3-5 year lifespan. Nearly half their life on Forteo at high doses.

Rat bones, unlike humans, continue to grow for the life of the rat. The cancers that were found in the rats were on the ends of the bones where new growth occurred.

A hip or spine fracture is a much better way to assure yourself a debilitating life and early death. There have been so many studies on hip and spine fracture and life expectancy I won't repeat.

BJohnson

May 13. 2010 16:45

Do you work for a drug company? it is not terrible advice to suggest that people know the risks of a drug they're offered before they meekly accept everything a doc prescribes. Physicians write a script for bone drugs as a knee-jerk response to even slight bone density declines, and if the first one doesn't work, they go to a second, third, and fourth without trying to figure out what's going on... I've heard that story over and over from friends in the older generation. You're right, rat bones aren't the same as human bones, and you seem to take that as a reason to dismiss the idea that Forteo might be a problem for humans. I take the opposite perspective: studies of rats are not good enough testing, to my mind, for what this stuff will do to people, but the FDA still accepts them as a reason to approve it! How many times to we have to hear the FDA yank an approved drug on the market for a decade or so becuase of previously undiscovered side effects before we get the message?

Hip & spine fracture are very serious, no doubt. Is that any reason to make yourself a guinea pig for a drug company? I don't think so. I'll try the approach Dr Brown recommends first, thanks.

Hope Falwell

July 2. 2010 13:55

I would like to know your opinion on using microcrystalline hydroxyapatite(MCHC) as a supplement to help build bone mass in  osteoporosis. Thank you.

jm

July 7. 2010 15:57

Hi jm,
MCHC can be a good source of calcium and phosphorus, but it does not contain all the 20 key bone nutrients.  If you use it make sure you are getting the other bone nutrients and that in particular you have enough magnesium.  I have seen folks develop arthritic symptoms if they take MCHC as a calcium source with adequate magnesium.  For details on the 20 key bone nutrients see www.betterbones.com/bonenutrition/20keybonenutrients.aspx
Best wishes, Susan

Susan Brown

April 21. 2011 18:21

I've been taking Forteo for the past 16 months.  I fought against it, but my very trusted general practitioner as well as the endocrinologist he recommended (voted best in the city by his peers) both continued to argue for my taking it, despite all my reasoning to the contrary. I brought in copies of Susan's articles; they were respectful of them, but still insisted that the risk to my overall well-being if I were to break a bone was far greater than taking Forteo.

About three weeks ago, the injection pen malfunctioned and I received 13 doses in one shot. Lilly reps assured me that I'd have no major side effects, but to stop taking drug for two weeks.

I continue to be very unhappy, but I do trust my general practitioner who has proven to be very wise in the past. I noted in one of Susan's articles re: Forteo that the maximum # of months to take drug is 18, although I'm scheduled to take it for 24 months (a total of 26 pens that deliver 28 injections a piece).

I'd love to hear from others who have completed Forteo in terms of the outcome. I'd also like to hear from Susan now that Forteo has been in use for 10 years. I'm wondering if she's learned more about this drug and if she's changed her thinking in any way related to Forteo.

C. Kennett

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