Is elevated bone-specific alkaline phosphatase an absolute contraindication to teriparatide?

The original label for Forteo gave a warning against using teriparatide in patients with an “unexplained alkaline phosphatase”. This was clearly meant to avoid the use of teriparatide in individuals who may have Paget’s Disease of the bone. Since Paget’s disease has an independent increased risk for osteosarcoma, there was concern about using teriparatide due to the rat osteosarcoma data. If the alkaline phosphatase could be explained by hepatic pathology, there was no concern. If the alkaline p...