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Peptide

Teriparatide (Forteo)

Teriparatide (brand name Forteo) is a recombinant form of the first 34 amino acids of human parathyroid hormone (PTH 1-34). It was FDA-approved in November 2002 as the first anabolic agent for osteoporosis treatment. Unlike antiresorptive drugs, teriparatide stimulates new bone formation. It is indicated for postmenopausal women and men with osteoporosis at high fracture risk, and for glucocorticoid-induced osteoporosis.

Research notice. This page is for education and research. Peptides may not be FDA-approved for human use and may only be legally available for research. Talk to a qualified clinician before considering any peptide.

Best evidence
Grade A
Conditions studied
3
Outcomes
13
Graded outcomes
7312

Evidence by condition

  • Strong
  • Moderate
  • Limited
  • Very limited

3 conditions, plus general outcomes

Osteoporosis

Osteoporosis: outcomes studied for Teriparatide (Forteo)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Glucocorticoid-Induced Osteoporosis

Teriparatide is superior to bisphosphonates for glucocorticoid-induced osteoporosis, with greater BMD increases at spine and hip.

Improves (the measure goes up)Moderate effect27 studies

Studies that measured glucocorticoid-induced osteoporosis

and 17 more in the citations list

Vertebral Fracture Risk

Meta-analysis showed 70% reduction in vertebral fracture risk (RR 0.30, 95% CI: 0.21-0.44). TOWER trial showed 80% reduction with cumulative incidence of 3.1% vs 14.5% placebo.

Improves (the measure goes down)Large effect22 studies

Studies that measured vertebral fracture risk

and 12 more in the citations list

Non-Vertebral Fracture Risk

Meta-analysis showed 38% reduction in non-vertebral fracture risk (RR 0.62, 95% CI: 0.44-0.87) in postmenopausal women with osteoporosis.

Improves (the measure goes down)Moderate effect22 studies

Studies that measured non-vertebral fracture risk

and 12 more in the citations list

Lumbar Spine BMD

24 months of treatment increased lumbar spine BMD by 10.7-13.4%, with 83% of patients showing >3% BMD increase.

Improves (the measure goes up)Large effect19 studies

Studies that measured lumbar spine bmd

and 9 more in the citations list

Femoral Neck BMD

24 months of treatment increased femoral neck BMD by 2.7-3.3%, with 40% of patients showing significant response.

Improves (the measure goes up)Moderate effect18 studies

Studies that measured femoral neck bmd

and 8 more in the citations list

Total Hip BMD

24 months of treatment increased total hip BMD by 3.0-3.7% from baseline.

Improves (the measure goes up)Moderate effect18 studies

Bone Health

Bone Health: outcomes studied for Teriparatide (Forteo)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Bone Formation Markers

Teriparatide rapidly increases bone formation markers (P1NP, osteocalcin) within weeks of treatment initiation.

Improves (the measure goes up)Large effect20 studies

Studies that measured bone formation markers

and 10 more in the citations list

Hip Fracture

  • Hip Fracture Prevention: changes; see studies
Hip Fracture: outcomes studied for Teriparatide (Forteo)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Hip Fracture Prevention

Long-term follow-up showed sustained lower incidence of hip fractures for up to 8 years after switching to antiresorptive agents.

Changes; see studiesModerate effect23 studies

Studies that measured hip fracture prevention

and 13 more in the citations list

General

  • Bone Mineral Density: improves
  • Safety/Tolerability: improves
  • Anti-Cancer Activity: improves
General: outcomes studied for Teriparatide (Forteo)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Bone Mineral Density

57 human trials and systematic reviews support this finding. Evidence includes systematic reviews/meta-analyses. Human clinical trial data available.

Improves (the measure goes up)Moderate effect18 studies

Studies that measured bone mineral density

and 8 more in the citations list

Safety/Tolerability

7 human trials and systematic reviews support this finding. Evidence includes systematic reviews/meta-analyses. Human clinical trial data available.

Improves (the measure goes up)Small effect12 studies

Studies that measured safety/tolerability

and 2 more in the citations list

Anti-Cancer Activity

3 preclinical studies support this finding. Primarily preclinical evidence.

Improves (the measure goes up)Small effect9 studies

Studies that measured anti-cancer activity

Angiogenesis

2 human trials support this finding. Human clinical trial data available.

Improves (the measure goes up)Small effect8 studies

Studies that measured angiogenesis

Cardiac Protection

2 human trials support this finding. Human clinical trial data available.

Improves (the measure goes up)Small effect8 studies

Studies that measured cardiac protection

Key findings

  • Glucocorticoid-Induced OsteoporosisOsteoporosisImproves (the measure goes up)
  • Vertebral Fracture RiskOsteoporosisImproves (the measure goes down)
  • Non-Vertebral Fracture RiskOsteoporosisImproves (the measure goes down)

Safety notes in the studies

  • Meta-analysis showed 70% reduction in vertebral fracture risk (RR 0.30, 95% CI: 0.21-0.44).
  • Meta-analysis showed 38% reduction in non-vertebral fracture risk (RR 0.62, 95% CI: 0.44-0.87) in postmenopausal women with osteoporosis.

Studies cited

54 studies from PubMed

  1. Long-term impact of teriparatide on bone mineral density, trabecular bone score, and fracture risk relative to total hip T-score: A two-decade, registry-based cohort studyBone, 2025 · PMID 40054513
  2. Real-world safety and effectiveness of romosozumab following daily or weekly administration of teriparatide in primary and secondary osteoporosis.Bone, 2025 · PMID 39826700
  3. Prolonged hypercalcemia induced by teriparatide: a case report and literature review.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2025 · PMID 40500389
  4. Efficacy and safety of teriparatide vs. bisphosphonates and denosumab vs. bisphosphonates in osteoporosis not previously treated with bisphosphonates: a systematic review and meta-analysisArch Osteoporos, 2024 · PMID 39289862
  5. The Fracture Incidence and Safety of Teriparatide and Bisphosphonate in Postmenopausal Women With Osteoporosis: A Meta-Analysis.Alternative therapies in health and medicine, 2024 · PMID 38064598
  6. Efficacy and safety of teriparatide vs. bisphosphonates and denosumab vs. bisphosphonates in osteoporosis not previously treated with bisphosphonates: a systematic review and meta-analysis of randomized controlled trials.Archives of osteoporosis, 2024 · PMID 39312040
  7. Delayed and significant hypercalcaemia due to teriparatide therapy: a case report and review.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2024 · PMID 38613637
  8. Protective effect of teriparatide against vancomycin-induced cytotoxicity in osteoblasts.Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association, 2023 · PMID 36371341
  9. Cardiac adverse events in bisphosphonate and teriparatide users: An international pharmacovigilance study.Bone, 2023 · PMID 36543300
  10. Potential effects of teriparatide (PTH (1-34)) on osteoarthritis: a systematic review.Arthritis research & therapy, 2023 · PMID 36609338
  11. Clinical efficacy of denosumab, teriparatide, and oral bisphosphonates in the prevention of glucocorticoid-induced osteoporosis: a systematic review and meta-analysis.Journal of orthopaedic surgery and research, 2023 · PMID 37349750
  12. Teriparatide induces angiogenesis in ischemic cerebral infarction zones of rats through AC/PKA signaling and reduces ischemia-reperfusion injury.Biomedicine & pharmacotherapy = Biomedecine & pharmacotherapie, 2022 · PMID 35220030
  13. Teriparatide therapy for medication-related osteonecrosis of the jaw: case report and literature review.Clinical medicine (London, England), 2022 · PMID 36220254
  14. Long-term cancer surveillance: results from the Forteo Patient Registry Surveillance Study.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2021 · PMID 33151378
  15. Assessment of the efficacy of teriparatide treatment for osteoporosis on lumbar fusion surgery outcomes: a systematic review and meta-analysis.Neurosurgical review, 2021 · PMID 32728969
  16. Comparison between teriparatide and bisphosphonates for improving bone mineral density in postmenopausal osteoporosis patients: A meta-analysis.Medicine, 2020 · PMID 32282692
  17. The Efficacy of Teriparatide in Improving Fracture Healing in Hip Fractures: A Systematic Review and Meta-Analysis.BioMed research international, 2020 · PMID 32904518
  18. Teriparatide and bisphosphonate use in osteoporotic spinal fusion patients: a systematic review and meta-analysis.Archives of osteoporosis, 2020 · PMID 33030619
  19. Update on the safety and efficacy of teriparatide in the treatment of osteoporosisTher Adv Musculoskelet Dis, 2019 · PMID 31554419
  20. Effect of teriparatide use on bone mineral density and spinal fusion: a narrative review of animal models.The International journal of neuroscience, 2019 · PMID 30587048
  21. Is Teriparatide Beneficial to Spinal Fusion Surgery in the Older Patient?: A Narrative Review.Clinical spine surgery, 2019 · PMID 30807365
  22. Teriparatide versus bisphosphonates for treatment of postmenopausal osteoporosis: A meta-analysis.International journal of surgery (London, England), 2019 · PMID 30890377
  23. The Forteo Patient Registry linkage to multiple state cancer registries: study design and results from the first 8 years.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2018 · PMID 29978254
  24. Fracture Risk Following Discontinuation of Teriparatide: A Review of the Literature.The Consultant pharmacist : the journal of the American Society of Consultant Pharmacists, 2018 · PMID 29996965
  25. Bone Mineral Density Response from Teriparatide in Patients with OsteoporosisJ Bone Metab, 2017 · PMID 28690468
  26. Teriparatide attenuates scarring around murine cranial bone allograft via modulation of angiogenesis.Bone, 2017 · PMID 28119180
  27. Effects of teriparatide versus alendronate for treatment of postmenopausal osteoporosis: A meta-analysis of randomized controlled trials.Medicine, 2017 · PMID 28538396
  28. Head-to-head comparisons of bisphosphonates and teriparatide in osteoporosis: a meta-analysis.Clinical and investigative medicine. Medecine clinique et experimentale, 2017 · PMID 28653616
  29. Challenges in studying very rare cancer outcomes and infrequent exposures: example of teriparatide and osteosarcoma.Annals of epidemiology, 2016 · PMID 27645108
  30. Effectiveness of Teriparatide on Fracture Healing: A Systematic Review and Meta-Analysis.PloS one, 2016 · PMID 27997614
  31. A systematic review on the use of daily subcutaneous administration of teriparatide for treatment of patients with osteoporosis at high risk for fracture in Asia.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2015 · PMID 25138261
  32. Literature review: The effects of teriparatide therapy at the hip in patients with osteoporosis.Bone, 2014 · PMID 25053463
  33. Effect of teriparatide on bone mineral density and fracture in postmenopausal osteoporosis: meta-analysis of randomised controlled trialsInt J Clin Pract, 2012 · PMID 22257045
  34. Randomized Teriparatide [human parathyroid hormone (PTH) 1-34] Once-Weekly Efficacy Research (TOWER) trial for examining the reduction in new vertebral fractures in subjects with primary osteoporosis and high fracture riskJ Clin Endocrinol Metab, 2012 · PMID 22723322
  35. A fracture does not adversely affect bone mineral density responses after teriparatide treatmentJ Bone Miner Metab, 2012 · PMID 21863393
  36. Effects of teriparatide on bone mineral density and bone turnover markers in Japanese subjects with osteoporosis at high risk of fracture in a 24-month clinical studyJ Bone Miner Metab, 2010 · PMID 20580870
  37. Effect of teriparatide on bone mineral density and biochemical markers in Japanese women with postmenopausal osteoporosis: a 6-month dose-response studyJ Bone Miner Metab, 2008 · PMID 18979163
  38. Teriparatide: a review of its use in osteoporosis.Drugs, 2008 · PMID 19093708
  39. Teriparatide (recombinant human parathyroid hormone 1-34) in postmenopausal women with osteoporosis: systematic review.Sao Paulo medical journal = Revista paulista de medicina, 2008 · PMID 19099162
  40. Teriparatide versus alendronate for treating glucocorticoid-induced osteoporosis: a meta-analysisArthritis Rheum, 2007 · PMID 17059367
  41. Teriparatide [Human PTH(1-34)]: 2.5 Years of Experience on the Use and Safety of the Drug for the Treatment of OsteoporosisJ Bone Miner Res, 2006 · PMID 16526024
  42. Teriparatide [human PTH(1-34)]: 2.5 years of experience on the use and safety of the drug for the treatment of osteoporosis.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2006 · PMID 16491282
  43. Teriparatide for severe osteoporosis.The Annals of pharmacotherapy, 2004 · PMID 14742769
  44. Teriparatide (Forteo) for osteoporosis.American family physician, 2004 · PMID 15117021
  45. A review of teriparatide and its clinical efficacy in the treatment of osteoporosis.Expert opinion on pharmacotherapy, 2004 · PMID 15155114
  46. Teriparatide (biosynthetic human parathyroid hormone 1-34): a new paradigm in the treatment of osteoporosis.Basic & clinical pharmacology & toxicology, 2004 · PMID 15228497
  47. Teriparatide for postmenopausal osteoporosis.Drug and therapeutics bulletin, 2004 · PMID 15587764
  48. Teriparatide: A bone formation treatment for osteoporosis.Drugs of today (Barcelona, Spain : 1998), 2004 · PMID 15645006
  49. Treatment of osteoporosis with Teriparatide rhPTH(1-34).Journal of musculoskeletal & neuronal interactions, 2004 · PMID 15758281
  50. Teriparatide: a review.Clinical therapeutics, 2004 · PMID 15262455
  51. Teriparatide (forteo) for osteoporsis.The Medical letter on drugs and therapeutics, 2003 · PMID 12571538
  52. Forteo approved for osteoporosis treatment.FDA consumer, 2003 · PMID 12715752
  53. Recombinant human PTH 1-34 (Forteo): an anabolic drug for osteoporosis.Cleveland Clinic journal of medicine, 2003 · PMID 12882381
  54. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosisN Engl J Med, 2001 · PMID 11568997