What is the black box warning associated with anabolic bone-building therapies like teriparatide?

• A. Osteoarthritis
• B. Osteoporosis
• C. Osteosarcoma
• D. Osteomalacia

Answer: (C)

The safety signal for anabolic bone-building therapies like teriparatide is a warning about osteosarcoma. Teriparatide stimulates bone formation by activating osteoblasts, which helps strengthen bone in osteoporosis, but animal studies showed an increased risk of osteosarcoma at high doses. Because of this potential risk, the FDA places a black box warning on these drugs and limits total use to about two years over a patient’s lifetime. In clinical practice, this means reserving teriparatide for patients with very high fracture risk who have not benefited from other treatments, and stopping after the two-year course. The other options—osteoarthritis, osteoporosis, and osteomalacia—are conditions or diseases, not the specific safety warning associated with this drug.