Teriparatide
FORTEO
Pronunciation: ter-i-PAR-a-tide (for-TAY-oe)
What it isAnabolic parathyroid-hormone receptor agonist; severe osteoporosis.
Why it mattersUnlike abaloparatide, it also has a labeled role in glucocorticoid-induced osteoporosis and the longest anabolic track record.
What it changesBone gained is lost unless an antiresorptive follows the treatment course; hypercalcemia and daily injection can limit use.
Pearls
- Cuts vertebral and nonvertebral fractures more than risedronate; hip benefit unproven.
- Two-year lifetime limit lifted if fracture risk stays high.
- Osteosarcoma boxed warning removed in 2020.
- First doses: transient orthostatic hypotension and tachycardia.
Teriparatide prescription history
Animated chart of estimated U.S. prescriptions per year, Osteoporosis meds (1975–2026). Teriparatide enters in 2002 (estimated).
FDA-approved for
- osteoporosis (2002)
Principal riskBone gained is lost unless an antiresorptive follows
Classes and tags
Clinical profile
Legacy pregnancy categoryUnknown / historical label unavailable
Defining liabilityGenerally tolerated at therapeutic doses; clinically important risks are agent-specific and increase with interactions or organ impairment.
FDA label
Read the full label on DailyMed ↗
NO BOXED WARNINGS
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Osteoporosis at high fracture risk (postmenopausal women; men with primary/hypogonadal osteoporosis; glucocorticoid-induced osteoporosis) | Adults | 20 mcg SC QD | 20 mcg SC QD | 20 mcg SC QD |
Renal No dosage adjustment specified; exposure increased in severe impairment (CrCl <30)
Hepatic Undefined
Use beyond 2 years lifetime only if patient remains at/returns to high fracture risk
Instructions
- Inject SC into thigh or abdominal region (not IV or IM)
- Give initially where patient can sit or lie down if orthostatic hypotension occurs
- Take supplemental calcium and vitamin D if dietary intake inadequate
- Discard the prefilled pen 28 days after first use
Available strengths
- inj 250 mcg/mL
Cautions
- Osteosarcoma — avoid in patients at increased baseline risk (open epiphyses, Paget's disease, bone metastases/skeletal malignancy history, prior skeletal radiation, hereditary predisposition)
- Hypercalcemia and cutaneous calcification/calciphylaxis — avoid in underlying hypercalcemic disorder
- Risk of urolithiasis
- Orthostatic hypotension with initial doses
- Digoxin toxicity risk from transient hypercalcemia
Adverse reactions
- Arthralgia
- Pain
- Nausea
- Dizziness
- Headache
- Hypertension
Pregnancy No human data; consider discontinuing when pregnancy is recognized
Lactation Unknown if excreted in milk; avoid use while breastfeeding
Cost
| Strength | #/mo | generic $/unit | CostPlus | |
|---|---|---|---|---|
| 250 mcg/mL | inj | per unit | $479.95/mL | offered |
Generic entry2023
Open Teriparatide in the interactive console ↗
Self-check
- What osteoporosis indication distinguishes teriparatide from abaloparatide?
Glucocorticoid-induced osteoporosis. - What should follow teriparatide to preserve bone gained?
An antiresorptive.