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Have osteoporosis, bone density test done, prescribed Zoledronic acid and Teriparatide injections. Do intravenous bisphosphonates work better than oral tablets?

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Orthopaedic Surgeon
Practicing since : 1994
Answered : 10347 Questions
Dear Doctor,
Someone at home has Osteoporosis, it was detected 6 months ago but only Calcium tablets were advised then. A detailed bone density test was done now. The doctor has prescribed annual Zoledronic acid injection (Novartis ), and Teriparatide injections . My question is:
1) Do intravenous Bisphosphanates work better than oral tablets ?
2) Teriparatide was prescribed together with Zolendronic acid - should one wait a few months first to see if bone resorption has been inhibited by the Bisphosphanate ? Many people seem to do well with Bisphosphanate alone. I was worried about the side effects of both treatments being done together.

BMD test results:
Spine: .816 gm/cm2 T score -3.0
Forearm radius : .209 g/cm2 T score -5.7
Femur Total : T score -1.8 , -1.5
Femur Neck T score -2.5,-2.1
Posted Mon, 21 May 2012 in Back Pain
Answered by Dr. Praveen Tayal 5 hours later
Thanks for posting your query.
The bone mineral density report is suggestive of osteoporosis in all the bones.
1. The effectiveness of once a year intravenous dose of bosphosphonates is similar to the weekly oral doses. But the side effects like gastric intolerance are lesser with intravenous dose. The cost of treatment is lesser with oral therapy.
2. The anabolic effect of teriparatide is reduced if given along with a bisphosphonate. It is best to give i.v. zoledronic acid, give a 1-month drug washout period gap and then start with Teriparatide therapy for best results.
The treating orthopedician can decide the best course of action after assessing the general condition of the patient.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Please accept my answer in case you do not have further queries.
Wishing you good health.
Dr. Praveen Tayal.
Above answer was peer-reviewed by
Follow-up: Have osteoporosis, bone density test done, prescribed Zoledronic acid and Teriparatide injections. Do intravenous bisphosphonates work better than oral tablets? 1 hour later
Dr. Tayal,
Thanks for the quick answer. I would like to know if Teriparatide has any side effects.

Answered by Dr. Praveen Tayal 1 hour later
Thanks for writing again.
Teriparatide is well tolerated. The common side effects include- dizziness, muscle cramps, fainting, constipation, rashes, itching, hypotension, nausea, heartburn, diarrhea, headache, pain, weakness, and depression.
All these side effects are not seen in all the individuals.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Above answer was peer-reviewed by
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