The management of osteoporosis has been dominated by the use of antiresorptive 
agents, such as bisphosphonates and raloxifene, which have been shown to 
effectively reduce the risk of osteoporotic fractures. Teriparatide, a 
recombinant human parathyroid hormone, has recently become available. It has an 
altogether different action. Teriparatide is an anabolic agent that primarily 
stimulates bone formation. This leads to an increase in bone volume and the bone 
structure and microarchitecture is restored by an increase in trabecular 
thickness and an increase in the number of connections between trabeculae. 
Clinically relevant studies on teriparatide in postmenopausal women and in men 
have shown that it significantly lowers the risk of fracture. Teriparatide 
should not be combined with bisphosphonates. There are no clear recommendations 
on the order of treatment with teriparatide and bisphosphonates. The high costs 
ofteriparatide have slowed the trajectory from registration to reimbursement in 
the Netherlands. Since 1 February 2005 teriparatide may be prescribed for 
postmenopausal women with serious osteoporosis i.e. with a minimum of 1 
osteoporotic fracture who (a) despite treatment with bisphosphonates or 
raloxifene after 2 prolapsed vertebrae once again have 1 or more fractures 
(inadequate response); (b) can tolerate neither bisphosphonates nor raloxifene; 
(c) are prescribed the drug by their treating medical specialist.