Bone drugs: teriparatide: practice question

A Pharmacology question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Pharmacology · Bone drugs: teriparatide

Sample item

A 68-year-old woman has had three vertebral fractures and a T-score of minus 3.5 despite two years of alendronate. An anabolic agent is planned. Which drug and which pattern of exposure produces net bone formation?

ATeriparatide, given as a once-daily subcutaneous pulseBTeriparatide, given as a continuous infusionCCalcitonin, given as a nasal sprayDAlendronate, given at a higher dose

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Teriparatide, given as a once-daily subcutaneous pulse

Intermittent exposure to parathyroid hormone fragment 1-34 preferentially stimulates osteoblasts and increases bone formation, while continuous exposure, as in hyperparathyroidism, drives osteoclastic resorption. Teriparatide is therefore given as a daily injection for a maximum of about two years. Antiresorptives such as bisphosphonates and calcitonin do not increase bone formation as strongly.

Option by option

A. Teriparatide, given as a once-daily subcutaneous pulse (correct)
Pulsatile parathyroid hormone exposure favours osteoblast activity and bone formation.
B. Teriparatide, given as a continuous infusion
Continuous exposure to parathyroid hormone increases resorption, as in primary hyperparathyroidism.
C. Calcitonin, given as a nasal spray
Calcitonin is a weak antiresorptive and does not build bone.
D. Alendronate, given at a higher dose
Higher-dose alendronate is an antiresorptive and the patient has already failed it.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

Questions about this Pharmacology question

What is the answer to this Pharmacology question?

The best answer is A, Teriparatide, given as a once-daily subcutaneous pulse. Intermittent exposure to parathyroid hormone fragment 1-34 preferentially stimulates osteoblasts and increases bone formation, while continuous exposure, as in hyperparathyroidism, drives osteoclastic resorption.

Why is "Teriparatide, given as a continuous infusion" not the answer?

Continuous exposure to parathyroid hormone increases resorption, as in primary hyperparathyroidism.

Why is "Calcitonin, given as a nasal spray" not the answer?

Calcitonin is a weak antiresorptive and does not build bone.

Why is "Alendronate, given at a higher dose" not the answer?

Higher-dose alendronate is an antiresorptive and the patient has already failed it.

What concept does this question test?

It tests Bone drugs: teriparatide in Pharmacology. Teriparatide is therefore given as a daily injection for a maximum of about two years. Antiresorptives such as bisphosphonates and calcitonin do not increase bone formation as strongly.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Bone drugs: teriparatide?

Learn drugs as classes, then the exception in each class that an examiner would pick. Then use the flashcards and the other Pharmacology questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.