Known safety concerns, contraindications, and risk factors.
Paget's disease of bone
Patients with Paget's disease are at elevated baseline risk for osteosarcoma; PTH analogs are absolutely contraindicated.
Unexplained elevated alkaline phosphatase
Elevated alkaline phosphatase of unknown origin may indicate occult bone pathology incompatible with anabolic bone therapy.
Prior skeletal radiation therapy
History of skeletal radiation increases osteosarcoma risk; PTH analogs are contraindicated in irradiated bone.
Severe renal impairment
Severe renal impairment causes 2.1x increase in abaloparatide AUC, significantly increasing toxicity risk.
Primary hyperparathyroidism or existing hypercalcemia
Pre-existing calcium dysregulation is exacerbated by PTH analogs, risking dangerous hypercalcemia.
Pediatric patients or open epiphyses
PTH analogs and growth-promoting peptides are contraindicated in patients with open epiphyses due to osteosarcoma risk and unpredictable growth effects.
Discontinuation without antiresorptive transition
Stopping anabolic therapy without initiating antiresorptive coverage causes rapid rebound bone loss that may exceed pre-treatment levels.