 Robert Filice, M.D. - Dr. Bob's Newsletter |
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Forteo Forteo was approved for the treatment of osteoporosis as recently as December 2002. This makes it a relatively new drug. Many physicians, including myself, prefer to be cautious about prescribing new drugs until more real world experience is reported. Not infrequently doctors and patients using newly released drugs get blind sided by unexpected side effects that didn't show up in the pre-approval studies. Known side effects of this drug are: Headache Asthenia Neck pain Hypertension Angina pectoris Syncope Nausea Constipation Dizziness Depression Insomnia Vertigo Forteo also has the disadvantage that it must be given by self-administered subcutaneous injections every day for up to two years. Studies suggest it helps reduce fracture rate by 50% in those with already diagnosed osteoporosis, and that it does so by supposedly stimulating the activity of the bone building cells (osteoblasts). Up to now, available pharmaceuticals have mostly worked by inhibiting the cells responsible for bone breakdown (osteoclasts). If true, I consider this to be a plus for this newer drug, however the drug literature about Forteo does not jive with the actual physiologic actions that are well known to be associated with naturally occurring parathyroid hormone. As a synthetic form of the human parathyroid hormone, one would expect Forteo's mode of action to match that of the natural hormone. Parathyroid hormone in the body has one clearly defined job description: if the blood calcium level falls too low, bring it back up again! In the body, here's how parathyroid hormone does that job: 1. Mobilizes calcium from bone: Although the mechanisms remain obscure, a well-documented effect of parathyroid hormone is to stimulate osteoclasts to reabsorb bone mineral, liberating calcium into blood. This begins the normal cycle of breakdown and build up of bone. Apparently "pulses' of increased parathyroid hormone may lead to a net positive effect on bone density. This is the same exact mechanism by which another natural therapy for osteoporosis, intravenous chelation therapy, also benefits patients with thin bones. Chelation causes a natural increase in parathyroid hormone secretion in response to the fact that it temporarily lowers blood calcium levels. 2. Enhancing absorption of calcium from the small intestine: Facilitating calcium absorption from the small intestine would clearly serve to elevate blood levels of calcium. Parathyroid hormone stimulates this process, but indirectly by stimulating production of the active form of vitamin D in the kidney. Vitamin D induces synthesis of a calcium-binding protein in intestinal epithelial cells that facilitates efficient absorption of calcium into blood. 3. Suppression of calcium loss in urine: In addition to stimulating fluxes of calcium into blood from bone and intestine, parathyroid hormone puts a brake on excretion of calcium in urine, thus conserving calcium in blood. This effect is mediated by stimulating tubular reabsorption of calcium. Another effect of parathyroid hormone on the kidney is to stimulate loss of phosphate ions in urine. In summary, I would not be a proponent of prescribing Forteo unless it were in a person with advanced osteoporosis who perhaps had already experienced a fracture from this disorder. I find that resistance exercises, dietary advice, natural hormone therapy, possibly chelation therapy if the patient also has circulatory issues, and well researched oral nutritionals (not calcium!) can bring the same benefits more safely, more naturally, and just as quickly as this pharmaceutical. |
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