Teriparatide
Pronunciation: ter-i-PAR-a-tide.
- Generic name
- teriparatide (recombinant human parathyroid hormone 1-34)
- Drug class
- Parathyroid hormone analogue (PTH 1-34); anabolic (bone-forming) osteoporosis treatment
- Form
- Injection, 250 mcg/mL, prefilled pen delivering 20 mcg per dose
- Route
- Subcutaneous injection
- Legal status
- Prescription-only
Availability and supply rules vary by country
Trade names by country: United States · United Kingdom · Canada · Australia · New Zealand
Australia: Forteo (6) · Full directory
What teriparatide (recombinant human parathyroid hormone 1-34) is and how it works
Teriparatide is a prescription-only injectable medicine used for severe osteoporosis in people at high risk of bone fracture. It is a lab-made form of part of the human parathyroid hormone and works by actively building new bone, rather than just slowing bone loss. (1) (3)
Teriparatide is given as a daily self-injection under the skin, exactly as your prescriber directs. It is generally used for a limited period rather than indefinitely -- your prescriber will explain how long your particular course of treatment is expected to last and will reassess this over time based on your ongoing fracture risk.
Mechanism of action: how teriparatide (recombinant human parathyroid hormone 1-34) works
Teriparatide is a recombinant fragment (amino acids 1-34) of human parathyroid hormone. Given intermittently as a once-daily injection, it produces a transient spike in PTH signalling that favours osteoblast (bone-building) activity over bone resorption, resulting in a net anabolic effect on bone -- in contrast to continuous PTH exposure, which favours bone breakdown. (1) (3)
What teriparatide (recombinant human parathyroid hormone 1-34) is used for
Severe osteoporosis at high fracture risk
Used to treat osteoporosis in postmenopausal women and in men at high risk of fracture, including osteoporosis linked to long-term steroid (glucocorticoid) treatment, when other approaches have not been suitable or have not been tolerated. (1) (3)
Before taking teriparatide (recombinant human parathyroid hormone 1-34)
Do not take / not appropriate for
- Do not use teriparatide if you have had a serious allergic reaction to teriparatide or any of its ingredients. (all countries) (1)
- In the European Union, United Kingdom, and (per the source reviewed) Canada, teriparatide is also formally contraindicated in: pregnancy and breastfeeding; existing high blood calcium (hypercalcaemia); severe kidney impairment; bone conditions other than osteoporosis such as Paget's disease of bone or hyperparathyroidism; unexplained rises in a liver/bone enzyme called alkaline phosphatase; previous radiation treatment involving the skeleton; and bone cancer or cancer that has spread to bone. In the United States, these same conditions are instead framed as situations where teriparatide is best avoided, decided together with the prescriber, rather than as formal contraindications -- discuss your full medical history with your prescriber regardless of country. (country-dependent -- see text) (3) (4) (1) (5)
- Not used in children, adolescents, or young adults whose bone growth plates have not yet closed (open epiphyses). (all countries) (1) (3)
Tell your clinician about
- Any history of bone cancer, cancer that has spread to bone, Paget's disease of bone, or previous radiation treatment involving the skeleton.
- Any history of high blood calcium (hypercalcaemia), kidney problems, or unexplained abnormal liver/bone enzyme (alkaline phosphatase) results.
- Whether you are pregnant, could become pregnant, or are breastfeeding.
- All other medicines you take, especially digoxin (a heart medicine).
How to take teriparatide (recombinant human parathyroid hormone 1-34)
- Injected under the skin (subcutaneously) in the thigh or abdomen, once a day, at around the same time each day.
- For the first few doses, it is sensible to sit or lie down somewhere comfortable, since some people feel briefly dizzy or light-headed within the first few hours after injecting.
- Follow the pen device instructions provided with your medicine carefully.
Procedures and treatment changes
Tell the treating team before surgery, procedures, or any medicine change. Do not alter treatment without the responsible clinician. (1) (2) (3) (4) (5) (6) (7)
Missed dose
If a dose is missed, contact your prescriber or pharmacist for guidance on how to proceed, rather than doubling up doses, since teriparatide is dosed once daily on an ongoing schedule.
Overdose
Seek urgent medical attention if too much teriparatide may have been injected, or if severe dizziness, fainting, nausea, or vomiting occur. (1)
Side effects
Side effects and their urgency vary; report severe, persistent, or concerning symptoms.
Joint pain (arthralgia).
What to notice: Joint pain (arthralgia).
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
General pain and leg cramps.
What to notice: General pain and leg cramps.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (3)
Nausea.
What to notice: Nausea.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1) (3)
Headache and dizziness.
What to notice: Headache and dizziness.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (3)
Injection site reactions.
What to notice: Injection site reactions.
What to do: Discuss persistent or troublesome symptoms with the treating clinician or pharmacist. (1)
Serious warnings
Dizziness or light-headedness shortly after a dose (orthostatic hypotension) — high caution
Symptoms: Feeling dizzy, light-headed, or faint, usually within about 4 hours of the injection, particularly with the first few doses.
Action: Sit or lie down until symptoms pass -- they usually resolve within minutes to a few hours on their own. Tell your prescriber if this happens, and seek urgent medical attention for a fall, fainting, or symptoms that do not settle. (1) (3)
History of bone cancer, bone metastases, Paget's disease of bone, or prior skeletal radiation — high caution
Symptoms: Not applicable -- this relates to who should have teriparatide considered by their prescriber in the first place, based on preclinical (animal) findings of bone tumours at high, prolonged doses, though this increased risk has not been confirmed in human studies to date.
Action: Make sure your prescriber knows your full bone-health and cancer history before starting, so they can weigh whether teriparatide is appropriate for you. (1) (2)
Signs of high blood calcium (hypercalcaemia) — emergency
Symptoms: Nausea, vomiting, constipation, low energy, or muscle weakness.
Action: Contact your prescriber promptly if these symptoms develop, especially if you also take digoxin, and seek emergency care for severe symptoms. (1) (3)
Interactions
Pregnancy, breastfeeding, kidney/liver function, age
Pregnancy
Teriparatide is not intended for use in pregnancy. In the European Union, United Kingdom, and Canada it is formally contraindicated in pregnancy; in the United States, the prescriber will re-evaluate treatment if pregnancy occurs or is being planned. Discuss pregnancy plans with your prescriber before starting. (1) (2) (3) (4) (5) (6) (7)
Breastfeeding
Breastfeeding is not recommended during treatment, and teriparatide is formally contraindicated during breastfeeding in the European Union, United Kingdom, and Canada. (1) (2) (3) (4) (5) (6) (7)
Children
Not used in children or adolescents with open growth plates (open epiphyses); safety and effectiveness in this group have not been established. (1) (2) (3) (4) (5) (6) (7)
Elderly
No specific dose adjustment based on age alone is described in the sources reviewed, but overall bone health, kidney function, and other medicines are considered by the prescriber regardless of age. (1) (2) (3) (4) (5) (6) (7)
Hepatic_impairment
Not specifically addressed with a dose adjustment in the sources reviewed for this dossier -- discuss any liver condition with your prescriber. (1) (2) (3) (4) (5) (6) (7)
Renal_impairment
Severe kidney impairment is a formal contraindication in the European Union, United Kingdom, and Canada; kidney function should be discussed with your prescriber in all countries. (1) (2) (3) (4) (5) (6) (7)
Source_ids
US-DAILYMED-TERIPARATIDE-FORTEO-2026,EU-EMA-FORSTEO-SMPC-2026,CA-HC-FORTEO-PM-2026 (1) (2) (3) (4) (5) (6) (7)
Monitoring
Before starting
- Baseline blood calcium level
- Kidney function
- Bone-health and cancer history review, including any prior skeletal radiation
During treatment
- Watching for dizziness or light-headedness after dosing, especially in the first weeks.
- Periodic reassessment of ongoing fracture risk to guide how long treatment should continue.
- Monitoring blood calcium in patients also taking digoxin.
Storage
Store in a refrigerator (36-46°F / 2-8°C) at all times, including during the period of use; do not freeze. Keep the pen protected from light and always recap it between uses. Follow the specific in-use storage window given in the leaflet for your product.
Professional information
Clinician-facing context only, sourced from the current US FDA prescribing information and EU/UK SmPCs; verify against the current full label before prescribing.
United States
Indication: Osteoporosis in postmenopausal women and men at high fracture risk; glucocorticoid-induced osteoporosis
Dose summary: 20 mcg subcutaneously once daily. No fixed lifetime maximum since the November 2020 label update; continuation beyond 2 years is an individualised decision based on ongoing fracture risk. Only hypersensitivity remains a formal contraindication; open epiphyses, bone metastases, prior skeletal radiation, and other metabolic bone disease are now framed as conditions in which use should be avoided, discussed case-by-case.
Renal context: Not set out with a specific dose adjustment in the source reviewed; renal function should be assessed as part of overall suitability. (1) (2)
European Union / United Kingdom
Indication: Osteoporosis in postmenopausal women and men at increased fracture risk; glucocorticoid-induced osteoporosis
Dose summary: 20 micrograms subcutaneously once daily. Maximum total treatment duration of 24 months in a patient's lifetime, not to be repeated. Formal contraindications include pregnancy, breastfeeding, pre-existing hypercalcaemia, severe renal impairment, metabolic bone disease other than primary osteoporosis (including Paget's disease and hyperparathyroidism), unexplained alkaline phosphatase elevation, prior skeletal radiation, and skeletal malignancy/bone metastases.
Renal context: Severe renal impairment is a formal contraindication in this label. (3) (4)
Hepatic guidance
Not specifically addressed with a dose adjustment in the sources reviewed.
Overdose note
Overdose may cause delayed hypotension, nausea, vomiting, and dizziness; manage supportively based on symptoms, including monitoring for changes in blood calcium. (1) (3)
Frequently asked questions
Is teriparatide available in the US, UK, Europe, Canada, Australia, and New Zealand?
Yes, it is approved and available in all of these regions, either as the originator brand Forteo or as an approved biosimilar/generic version (for example, Teriparatide Teva in New Zealand). (1) (3) (4) (5) (6) (7)
Does teriparatide still carry a warning about bone cancer (osteosarcoma)?
The US boxed warning about osteosarcoma, along with the fixed 2-year lifetime treatment limit, was formally removed by the FDA in November 2020, after large-scale real-world data covering millions of patients found no increased osteosarcoma risk in people treated with teriparatide. The topic is still discussed in the label as background (it was originally based on findings in rats given very high, prolonged doses), and some countries, including the European Union and United Kingdom in the sources reviewed, still apply a 24-month lifetime maximum and list bone-cancer-related conditions as formal contraindications. Your prescriber can explain what applies in your situation. (1) (2) (3)
Is it normal to feel dizzy after an injection?
Brief dizziness or light-headedness within a few hours of a dose, especially with the first few injections, is a recognised effect related to a temporary drop in blood pressure on standing. It usually settles on its own within minutes to a few hours. Sitting or lying down until it passes is sensible, and it is worth telling your prescriber, especially if it happens repeatedly or you feel faint. (1) (3)
What is the mechanism of action of teriparatide (recombinant human parathyroid hormone 1-34)?
Teriparatide is a recombinant fragment (amino acids 1-34) of human parathyroid hormone. Given intermittently as a once-daily injection, it produces a transient spike in PTH signalling that favours osteoblast (bone-building) activity over bone resorption, resulting in a net anabolic effect on bone -- in contrast to continuous PTH exposure, which favours bone breakdown. (1) (3)
What is the generic name of Teriparatide?
The generic name is teriparatide (recombinant human parathyroid hormone 1-34). (1)
What class of drug is teriparatide (recombinant human parathyroid hormone 1-34)?
Teriparatide is classed as: Parathyroid hormone analogue (PTH 1-34); anabolic (bone-forming) osteoporosis treatment. (1)
References
- FORTEO (teriparatide injection) -- full prescribing informationU.S. Food and Drug Administration / DailyMed (NIH), full prescribing information, Eli Lilly and Company · United States · accessed 2026-07-29 · source 1
- Teriparatide and Osteosarcoma Risk: History, Science, Elimination of Boxed Warning, and Other Label UpdatesJBMR Plus (peer-reviewed journal, Krege et al. 2022), summarising the FDA's own label-change rationale · United States · accessed 2026-07-29 · source 2
- Forsteo, INN-teriparatide -- EPAR Product InformationEuropean Medicines Agency (EMA), Summary of Product Characteristics · European Union · accessed 2026-07-29 · source 3
- Forsteo 20 micrograms/80 microlitres solution for injection in pre-filled pen -- Summary of Product Characteristicselectronic medicines compendium (emc), United Kingdom -- Eli Lilly and Company Limited · United Kingdom · accessed 2026-07-29 · source 4
- FORTEO (teriparatide) -- Product MonographHealth Canada product monograph · Canada · accessed 2026-07-29 · source 5
- FORTEO teriparatide (rbe) 250 microgram solution for injection cartridge -- ARTG registrationTherapeutic Goods Administration (TGA), Australia · Australia · accessed 2026-07-29 · source 6
- Teriparatide Teva / Forteo -- Medsafe data sheets and Pharmac medicine-funding noticeMedsafe (New Zealand regulator) data sheet listing plus Pharmac (NZ government medicines-funding agency) medicine notice · New Zealand · accessed 2026-07-29 · source 7
Brand names by country
Single-ingredient teriparatide (recombinant human parathyroid hormone 1-34) names are shown separately by country. Product availability, strengths, and supply rules can change; combination products are not included here.
Priority countries
United States
- Forteo250 ug/mL · eli lilly and company
- Bonsity250 ug/mL · alvogen inc.
United Kingdom
- Forsteo (4)MHRA licensed emc smpc confirmed · 20 micrograms/80 microlitres prefilled pen · Eli Lilly and Company Limited
Canada
- FORTEO
Australia
- Forteo (6)TGA ARTG registered 2003-05-22 confirmed · 250 mcg/mL cartridge · Eli Lilly Australia Pty Ltd
New Zealand
- Teriparatide Teva (7)Medsafe approved standard brand confirmed · not specified in fetched source · Teva
View brands in additional countries.
European Union
Forsteo (3)