Would you consider PTH analogue in a patient with mildly elevated PTH?  

This is a complicated question because there is not any substantial literature. Almost all clinical trials with teriparatide and abaloparatide excluded patients with elevated PTH levels. However, there is considerable anecdotal experience. I have surveyed many colleagues with considerable experience...

If you have a patient with osteoporosis in whom you are considering treatment with a PTH analog, or indeed any agent, the first step would be to ensure that the patient does not have secondary hyperparathyroidism from Vitamin D deficiency by checking a 25- hydroxy vitamin D level. Once you have done...