Would you recommend teriparatide (Forteo) or zoledronate (Reclast) for a patient with severe osteoporosis who cannot take oral bisphosphonates because of esophageal strictures and in whom HRT and raloxifene (Evista) are contraindicated?
—PAMELA FERLAND, MSN, APRN, Danielson, Conn.

Forteo and Reclast are the newest osteoporosis drugs and less likely to produce GI problems than the bisphosphonates. Forteo is recommended for 24 months, with ample calcium and vitamin D supplementation. According to some information, Forteo is the only treatment that actually grows new bone (instead of strengthening existing bone). Some protocols recommend Forteo first followed by Reclast to help strengthen the new bone matrix. Both drugs are quite expensive and have some significant side effects. Most insurance companies require rigorous pre-approval before paying for these medications.
—Sherril Sego, MSN, FNP