Healthcare professionals should carefully weigh the intended benefits of teriparatide versus the theoretical risks in patients with a history of cancer such as

• the possibility of the presence of micrometastatic tumor cells in the bone marrow even after several years of the patient appearing to be cancer-free, and
• the potential effect of a high-bone-turnover state on those cells.1

A stimulatory effect of teriparatide on hematopoietic stem cells is also a theoretical concern for patients with a history of hematologic cancers.1

Teriparatide is contraindicated in patients with prior external beam or implant radiation therapy to the skeleton.2

Patients with skeletal malignancies or bone metastases should be excluded from treatment with teriparatide.2

For a full list of contraindications, please refer to the summary of product characteristics of Forsteo.2

The most common cancers to metastasize to the bone (in decreasing order of frequency) are

• breast
• prostate
• lung
• colon
• stomach
• bladder
• uterus
• rectum
• thyroid, and
• kidney.3

Additional factors affecting the risk of bone metastasis include

• TNM classification, and
• estrogen receptor status in patients with a history of breast cancer.3

Patients with a history of cancer were not specifically recruited for any teriparatide clinical trials.4

Exclusion criteria for teriparatide clinical trials included

• patients with a history of carcinoma in the previous 5 years, or
• patients currently being evaluated for suspected carcinoma.4

Patients allowed to participate in teriparatide clinical trials included

• patients who had undergone excision of superficial lesions of the skin (eg, basal cell or squamous cell carcinoma), or
• patients who had a history of carcinoma in situ of the cervix or uterus.4