Biosimilar product from Gedeon Richter plc has been authorized in the European Union. In October 2019, the US FDA approved a recombinant teriparatide product. In June 2020, the Committee for Medicinal Products for Human Use (CHMP) of the European Medicines Agency (EMA) recommended the approval of the biosimilar products Qutavina and Livogiva. Qutavina and Livogiva were approved for medical use in the European Union in August 2020. Osnuvo was approved for medical use in Canada in January 2020. Combined teriparatide and denosumab Combined teriparatide and denosumab increased BMD more than either agent alone and more than has been reported with approved therapies. Combination treatment might, therefore, be useful to treat patients at high risk of fracture by increasing BMD. However, there is no evidence of fracture rate reduction in patients taking a teriparatide and denosumab combination. The first such trial was published by Leder et al. in Lancet in 2013 with further data subsequently published in JCEM in a trial of post menopausal osteoporotic women demonstrating larger bone mineral density increases in the spine and hip with combination therapy compared to either drug alone. Society and culture Teriparatide can be used off-label to speed fracture repair and treat fracture nonunions. It has been reported to have been successfully used to heal fracture nonunions. Generally, due to HIPAA regulations, it is not publicized when American athletes receive this treatment to improve fracture recovery. But an Italian football player, Francesco Totti, was given teriparatide after a tibia/fibula fracture, and he unexpectedly recovered in time for the 2006 World Cup. It has been reportedly used by Mark Mulder of the Oakland A's to recover from a hip fracture before the 2003 MLB playoffs and Terrell Owens to recover from an ankle fracture before the 2005 Super Bowl. Teriparatide is currently being trialled with Zoledronic acid as a treatment for Osteogenesis Imperfecta to reduce the risk of broken bones. The trial is due to end in 2023. References External links Eli Lilly and Company brands Osteoporosis drugs Parathyroid hormone receptor agonists