Summary
Teriparatide is the active 34 amino acid fragment of parathyroid hormone that, injected daily, builds new bone; it has been FDA approved since 2002 to treat osteoporosis (thin, fragile bones) in people at high risk of fracture. In the pivotal trial of 1,637 postmenopausal women, 20 micrograms daily reduced new vertebral (spine) fractures by 65% and nonvertebral fragility fractures (breaks elsewhere from minor falls) by 53% over a median 21 months, and in the VERO trial it caused fewer new vertebral fractures than risedronate, a standard osteoporosis pill (5.4% versus 12.0%). It is a prescription drug available as brand, biosimilar (a near copy of a biologic drug), and generic products, with no compounding role.
What is Teriparatide?
Teriparatide is a recombinant fragment of human parathyroid hormone (amino acids 1 to 34), a bone anabolic agent. It is also known as Forteo, PTH (1-34), Recombinant human parathyroid hormone 1-34, Bonsity, rhPTH(1-34).
How does it work?
Given once daily as a brief pulse, teriparatide activates the PTH1 receptor on osteoblasts and stimulates new bone formation more than resorption, increasing trabecular bone density and connectivity. Continuous exposure to parathyroid hormone has the opposite, catabolic effect, which is why the drug is dosed as a single daily subcutaneous injection. The anabolic window narrows after 18 to 24 months as resorption catches up.
| Cluster | Other peptides |
|---|---|
| Routes | Subcutaneous injection once daily (prefilled pen) |
| Conditions studied | Osteoporosis |
| Record | v3, draft, verified Sep 23, 2026 |
FDA-approved uses of Teriparatide
Yes, since 2002. The Forteo label covers postmenopausal women with osteoporosis at high risk for fracture (where it reduces vertebral and nonvertebral fractures), men with primary or hypogonadal (low testosterone) osteoporosis at high risk for fracture (to increase bone mass), and men and women with osteoporosis from sustained systemic glucocorticoid therapy, long term steroid medicines such as prednisone, at high fracture risk, including those who failed or cannot tolerate other therapy. Generic and 505(b)(2) versions, copies approved through a shortened FDA pathway, followed. It is prescription only. [3]
What does the evidence say about Teriparatide?
Large randomized placebo controlled and active comparator trials. Neer 2001 (n = 1,637) found 20 ug daily reduced new vertebral fractures from 14% to 5% (relative risk 0.35) and nonvertebral fragility fractures from 6% to 3% (relative risk 0.47) and raised lumbar spine bone density by 9% over a median 21 months. VERO 2018 (n = 1,360) found new vertebral fractures in 5.4% on teriparatide versus 12.0% on risedronate over 24 months (risk ratio 0.44).
| Evidence type | Indexed studies | Participants (human) |
|---|---|---|
| Human randomized trials | 2 | 2997 |
| Human observational studies | 0 | n/a |
| Animal studies | 0 | n/a |
| All indexed studies | 2 | 2,997 |
Human evidence
Neer 2001: 1,637 postmenopausal women with prior vertebral fractures randomized to placebo, 20 ug, or 40 ug teriparatide daily; the trial was stopped early after a median 21 months. New vertebral fractures occurred in 14% on placebo versus 5% on 20 ug (relative risk 0.35, 95% CI 0.22 to 0.55); nonvertebral fragility fractures 6% versus 3%. VERO 2018: 1,360 postmenopausal women with severe osteoporosis randomized to teriparatide 20 ug daily or oral risedronate 35 mg weekly for 24 months; new vertebral fractures 5.4% versus 12.0% (risk ratio 0.44, 95% CI 0.29 to 0.68), clinical fractures 4.8% versus 9.8%.
Animal evidence
In rats given teriparatide for most of their lifespan at 3 to 60 times the human exposure, osteosarcoma occurred in a dose dependent manner. This finding led to the original boxed warning and the 2 year lifetime limit; postmarketing surveillance over nearly two decades found no increased osteosarcoma in humans, and FDA removed the boxed warning in 2020. Monkey studies showed bone gain without tumors.
Key studies
| Study | Design and population | Outcome | Grade |
|---|---|---|---|
| Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis2001 PMID 11346808 | Randomized, double blind, placebo controlled trial, median 21 monthsn = 1,637 Postmenopausal women with at least one prior vertebral fracture | New vertebral fractures 5% with 20 ug versus 14% placebo (relative risk 0.35); nonvertebral fragility fractures 3% versus 6%; lumbar spine BMD up 9% | Evidence: Human RCT evidence |
| Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial2018 PMID 29129436 | Randomized, double blind, double dummy, active comparator trial, 24 monthsn = 1,360 Postmenopausal women with severe osteoporosis and at least two moderate or one severe vertebral fracture | New vertebral fractures 5.4% with teriparatide versus 12.0% with risedronate (risk ratio 0.44); clinical fractures 4.8% versus 9.8% | Evidence: Human RCT evidence |
Conditions studied
| Condition | Grade | Note |
|---|---|---|
| Osteoporosis | Evidence: Human RCT evidence | New vertebral fractures 5% versus 14% on placebo; in VERO, 5.4% versus 12.0% with risedronate in severe osteoporosis; FDA approved as Forteo. |
Is Teriparatide legal in the United States?
FDA and compounding status
FDA approved as Forteo in November 2002 for postmenopausal women with osteoporosis at high fracture risk, men with primary or hypogonadal osteoporosis, and glucocorticoid induced osteoporosis. A 505(b)(2) product (Bonsity, 2019) and generic teriparatide injections have since been approved. In November 2020 FDA approved label changes removing the boxed warning for osteosarcoma and the 2 year lifetime treatment limit. Because approved products exist, compounding teriparatide is not permitted except in narrow patient specific circumstances.
WADA status
Not WADA prohibited. Not named on the current prohibited list. Athletes should still confirm against the list in force for their season.
Regulatory timeline
- FDA
FDA approves Forteo (teriparatide) for osteoporosis
FDA approved teriparatide injection (Forteo), a recombinant parathyroid hormone fragment, for postmenopausal women with osteoporosis at high risk of fracture and to increase bone mass in men with primary or hypogonadal osteoporosis.
Regulatory: FDA approvedSource: Drugs@FDA: Forteo (teriparatide) NDA 021318
Teriparatide dose on the FDA label
Doses below are quoted from the FDA label for its approved uses, plus the doses used in the pivotal trials where noted. The prescriber sets the dose; PeptideAgent does not recommend doses or protocols.
FDA label (Forteo, DailyMed): 20 mcg injected subcutaneously once daily into the thigh or abdominal region, with supplemental calcium and vitamin D based on individual need. The first doses are given where the patient can sit or lie down in case of orthostatic hypotension. Use for more than 2 years during a patient's lifetime should be considered only if the patient remains at or has returned to a high risk for fracture. In Neer 2001 the 40 mcg dose added no fracture benefit over 20 mcg and caused more side effects.
Routes reported
| # | Route |
|---|---|
| 1 | Subcutaneous injection once daily (prefilled pen) |
What are the side effects and interactions of Teriparatide?
Side effects
| # | Reported side effect |
|---|---|
| 1 | Transient hypercalcemia (11% of the 20 ug group in Neer 2001 versus 2% placebo, usually mild) |
| 2 | Dizziness (9% versus 6%) and leg cramps (3% versus 1%) |
| 3 | Nausea, headache, and orthostatic hypotension in the first doses |
| 4 | Injection site reactions |
| 5 | Hyperuricemia and increased urinary calcium |
| 6 | Osteosarcoma in rats at high lifetime doses; no increase detected in humans in postmarketing surveillance, boxed warning removed in 2020 |
Interactions
| # | Interaction |
|---|---|
| 1 | Digoxin: teriparatide induced hypercalcemia can increase sensitivity to digoxin toxicity |
| 2 | Hydrochlorothiazide: modest additive rise in serum calcium |
| 3 | Bisphosphonates or denosumab given at the same time blunt the bone density gain; sequential use is standard |
Contraindications
| # | Contraindication |
|---|---|
| 1 | Hypersensitivity to teriparatide |
| 2 | Conditions with increased baseline osteosarcoma risk: Paget disease of bone, unexplained elevated alkaline phosphatase, open epiphyses, prior skeletal radiation (per the 2020 label these are risk factors to avoid rather than absolute bars) |
| 3 | Bone metastases or skeletal malignancy |
| 4 | Pre-existing hypercalcemia or hyperparathyroidism |
| 5 | Pregnancy and breastfeeding |
How do people access Teriparatide legally?
Typical cost: Brand Forteo has a manufacturer list price of 4,289.89 USD per pen, and one pen is a 28 day supply. Generic teriparatide pens cost about 1,036 to 1,146 USD with a discount card at the lowest-priced pharmacies, against average retail prices of about 2,977 to 3,214 USD (checked 2026-09-22). The Forteo savings card can bring a covered commercial prescription to 4 USD a month. Medicare Part D and most commercial plans cover it with prior authorization for high fracture risk.
Verified access options
Step 1
Prescription from a licensed provider (usually endocrinology, rheumatology, or primary care) filled at a retail or specialty pharmacy.
Step 2
Prior authorization typically requires a documented fragility fracture, very low bone density, or failure of oral bisphosphonates.
Step 3
Not available through compounding or telehealth peptide clinics.
Access paths are verified against public regulatory records and prescriber licensing. We never list unlicensed vendors.
Compare Teriparatide
Frequently asked questions
How well does teriparatide prevent fractures?
In the pivotal trial of 1,637 postmenopausal women with prior vertebral fractures, 20 ug daily for a median 21 months reduced new vertebral fractures from 14% to 5% (a 65% relative reduction) and nonvertebral fragility fractures from 6% to 3%. In the VERO head to head trial, 5.4% of women on teriparatide had a new vertebral fracture over 2 years versus 12.0% on risedronate. [1] [2]
Does teriparatide cause cancer?
Rats given teriparatide for most of their lives at 3 to 60 times human exposure developed osteosarcoma, which led to a boxed warning and a 2 year lifetime limit at approval. After nearly two decades of postmarketing surveillance found no increase in osteosarcoma in treated patients, FDA removed the boxed warning and the 2 year limit in November 2020. People with Paget disease, prior skeletal radiation, or open growth plates are still advised to avoid it. [1] [3]
What are the side effects of teriparatide?
The most common are transient rises in blood calcium (11% versus 2% on placebo in the pivotal trial), dizziness (9% versus 6%), leg cramps, nausea, and injection site reactions. Orthostatic lightheadedness can occur after the first few doses, so the label advises sitting or lying down for the first injections. [1] [3]
What is the teriparatide (Forteo) dose on the FDA label?
20 mcg injected under the skin of the thigh or abdomen once a day from a prefilled pen, with calcium and vitamin D as needed. The label advises giving the first doses sitting or lying down because of orthostatic hypotension, and says use beyond 2 years in a lifetime should be considered only if fracture risk remains high. Bone gains fade after stopping unless an antiresorptive such as a bisphosphonate or denosumab follows. [2] [3]
How much does teriparatide cost?
Brand Forteo has a manufacturer list price of 4,289.89 USD per pen, a 28 day supply. A published discount-card price source checked 2026-09-22 showed generic teriparatide pens from about 1,036 to 1,146 USD with a discount card, against average retail prices of about 2,977 to 3,214 USD. Most insurers including Medicare Part D cover it with prior authorization for high fracture risk, and the Forteo savings card lets eligible commercially insured patients pay as little as 4 USD a month. [3] [5] [6] [7] [8]
Is teriparatide banned by WADA?
No. Parathyroid hormone analogs are not named on the WADA Prohibited List. Athletes should still confirm with their anti-doping organization, since the list is updated every January. [4]
Teriparatide vs abaloparatide: what is the difference?
Both are daily injectable PTH receptor agonists. Teriparatide is PTH(1-34); abaloparatide is a PTH related protein analog that favors a transient receptor conformation and causes less hypercalcemia. Abaloparatide's placebo controlled trial showed an 86% relative reduction in new vertebral fractures, teriparatide's showed 65%, but the trials enrolled different populations and no fracture endpoint trial has compared them directly. Teriparatide has generics and a longer safety record. [1] [3]
Decisions about starting, stopping, or combining any treatment belong with a licensed clinician who knows your history.
From the blog
- Peptides for men, ranked by human evidence
hCG, GLP-1 drugs, teriparatide, and tesamorelin have human trials and a lawful route. PT-141 is off-label for men, and kisspeptin and melanotan II have no lawful path. Ranking, legality, and WADA.
- Peptides for women, ranked by human evidence
GLP-1 drugs, teriparatide, abaloparatide, and Vyleesi (PT-141) have real trials in women. Kisspeptin is research-only and GHK-Cu rests on small skin studies. The ranking and legal status.
Sources
Numbered citations above point to these primary sources. PubMed entries link to the indexed abstract.
- [1]Neer RM et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001PubMed 11346808, 2001
- [2]Kendler DL et al. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO). Lancet 2018PubMed 29129436, 2018
- [3]FDA prescribing information for Forteo (teriparatide injection), via DailyMedFDA, 2026
- [4]WADA Prohibited ListWADA, 2026
- [5]Manufacturer state price disclosure sheet for teriparatide injection (brand): wholesale acquisition cost per pen, accessed 2026-09-222025
- [6]Published cash-price comparison for generic teriparatide injection pens, discount-card and average retail prices, accessed 2026-09-222026
- [7]Published cash-price comparison for generic teriparatide referencing the brand pen, discount-card and average retail prices, accessed 2026-09-222026
- [8]Manufacturer savings and support program terms for brand teriparatide injection, accessed 2026-09-222026
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PeptideAgent. (2026, September 23). Teriparatide: evidence, legality, and access. https://peptideagent.ai/peptides/teriparatide- HTML link
<a href="https://peptideagent.ai/peptides/teriparatide">Teriparatide: evidence, legality, and access</a>, PeptideAgent, updated September 23, 2026.