Novel Precision Medicine Approach to Treatment of Osteoporosis Based on Bone Turnover

Eligibility Criteria

• 1. Diagnosed Osteoporosis by DXA (BMD t-score ≤ -2.5 with or without fragility fractures)
• 2. Treatment naive with respect to with anabolic or antiresorptive bone drugs.
• 3. Premenopausal, menopausal, and post-menopausal females.
• 4. 45 years old and older.
• 5. Presence or absence of diabetes
• 6. Normal levels of Vitamin D
• 7. Absence of all exclusion criteria on clinical workup
• 1. Pregnant or trying to become pregnant or are breastfeeding.
• 2. Participation in a study of an investigational drug during the past 30 days.
• 3. Treatment with anabolic or antiresorptive bone drugs.
• 4. Use of systemic anticoagulation (blood thinner)
• 5. Planned or anticipated oral surgery within the next 12 months.
• 6. Allergy to the antibiotics demeclocycline or tetracycline.
• 7. Planning to move out of the area within 18 months of the study.
• 8. Inability to stand or sit upright for at least 30 minutes.
• 9. Chronic alcoholism and/or drug addiction.
• 10. Prior radiation therapy (external beam or implant radiation) involving the skeleton (only if randomized to the bone forming drug (anabolic Forteo®)).
• 11. Systemic illnesses or organ diseases that may affect bone (except type 1 or type 2 Diabetes Mellitus).
• 12. Clinical condition that may limit study participation (e.g., heart diseases (unstable angina), lung diseases (severe COPD), other infections).
• 13. Abnormalities of the esophagus (tube connecting the mouth to the stomach) which delay esophageal emptying such as stricture (narrowing) or achalasia (a condition that prevents normal swallowing).
• 14. Have other bone diseases that are not linked to age or menopause.
• 15. Have a history of malignancy (cancer), not including non-melanoma skin cancer.
• 16. Vitamin D (Calcidiol) level below the normal range (below 20ng/mL).
• 17. AFTER RANDOMIZATION: If randomized to Group 1 Teriparatide and radius BMD t-score is less than -3.5 and does not sign consent to continue in the study.