The Treatment of Osteoporosis Using a Combination of Teriparatide (Forteo) and Denosumab

Exclusion Criteria

• •The use of drugs known to affect skeletal or calcium homeostasis.
• •Multiple vertebral fractures or severe lumbar degenerative changes with fewer than 2 evaluable lumbar vertebrae
• •Current use of anti-resorptive medicines
• •* Use of Hormone/Estrogen Therapy, raloxifene or calcitonin within the past 3 months
• •* Use of oral bisphosphonate for more than 4 months within the past 2 years or more than 5 years total cumulative bisphosphonate use in the past 10 years
• •* Use of intravenous ibandronate within the past 18 months
• •* Use of intravenous zoledronic acid within the past 4 years
• •* A history of a symptomatic renal stone within the past 3 years or history of multiple symptomatic renal stones
• •* Skeletal Disorders other than osteoporosis including: Hypercalcemia, hyperparathyroidism, Paget's Disease or osteomalacia
• •* Untreated or uncontrolled thyroid disease
• •* Elevated Bone Specific Alkaline Phosphatase level
• •* History of external or internal radiation therapy
• •* Renal insufficiency with estimated GFR below 30 ml/min
• •* Liver function tests (ALT/AST) more than 1.5 times the upper limit of normal
• •* Clinically significant hyperuricemia or active gout
• •* Any contraindications to receipt of Teriparatide or Denosumab (including hypocalcemia)
• •* History of an atypical fracture of the femoral shaft