Abaloparatide

How it works

It selectively activates the PTH1 receptor in a way that favours bone formation, stimulating osteoblast activity and increasing bone mineral density.

Prescribing in practice

• Treatment duration is limited and lifetime cumulative use of anabolic skeletal agents is restricted because of a theoretical osteosarcoma concern observed in animal studies, so prescribing should follow the SPC limits.
• It is given by daily subcutaneous injection and can cause orthostatic hypotension and palpitations, particularly after the first doses.
• Following a course, sequential antiresorptive therapy is generally needed to maintain the gains in bone density.

Monitoring

Monitor for orthostatic symptoms after injection and check calcium status, with assessment of bone mineral density to guide ongoing osteoporosis management.

Counselling the patient

• A daily injection that builds new bone to reduce fracture risk.
• Sit or lie down if you feel dizzy or light-headed after an injection, especially at first.
• This is a time-limited course, after which another osteoporosis medicine is usually started.

Evidence & guidelines

Abaloparatide reduced vertebral and non-vertebral fractures in the ACTIVE trial, supporting its use as an anabolic osteoporosis therapy as described in the SPC.