Peptide

Teriparatide

Active fragment of parathyroid hormone that stimulates bone formation. Used in severe osteoporosis with high fracture risk.

Regulatory status

Approved (FDA / EMA)

Family

Parathyroid hormone analog (fragment 1-34)

Scientific evidence

Very high

Number of findings

Where it acts

Bones and muscles · Hormones and metabolism

Also known as

teriparatide, PTH(1-34), Forteo, Forsteo, Movymia, Terrosa

Regulatory status

FDA (US): Approved (2002, Forteo) for postmenopausal osteoporosis at high risk of fracture, osteoporosis in men, and glucocorticoid-induced osteoporosis.

EMA (EU): Approved (2003, Forsteo; later biosimilars such as Movymia and Terrosa) for osteoporosis in postmenopausal women and in men at high risk of fracture, and glucocorticoid-induced osteoporosis.

Dose

20 µg subcutaneously once a day; in the EU for a maximum of 24 months in a lifetime (FDA Forteo and EMA Forsteo labels).

Safety

Dizziness, leg cramps, nausea, hypotension on standing, mild rise in calcium. Do not use in children or young people with growing bones, Paget's disease, prior bone radiotherapy, or bone cancer. In rats it increased osteosarcoma. Only with a prescription.

Interactions

With digoxin, hypercalcemia may favor toxicity.

Differences between women and men

Approved in postmenopausal women and in men. Must not be used in pregnancy or breastfeeding.

Effect by goal · level of evidence

Fewer fractures in postmenopausal osteoporosis

reduces Very high RCT (AA) in people

−65% vertebral fractures

RCT with 1,637 women (median 21 months): new vertebral fractures in 5% with 20 µg versus 14% with placebo (relative risk 0.35) and non-vertebral fractures in 3% versus 6%.

View the study (RCT) →

Better than risedronate in severe osteoporosis

reduces High RCT (AA) in people

−56% vs risedronate

VERO trial with 1,360 women over 2 years: new vertebral fractures in 5.4% with teriparatide versus 12.0% with risedronate, and clinical fractures in 4.8% versus 9.8%.

View the study (RCT) →

In depth

Where it acts

Bones and muscles, Hormones and metabolism

How it works

One daily injection produces a brief spike of PTH. This intermittent stimulus activates osteoblasts and forms new bone, the opposite of what happens with a continuous excess of PTH. It increases bone density and quality.

What the evidence says

In people

Fewer fractures in postmenopausal osteoporosis. RCT with 1,637 women (median 21 months): new vertebral fractures in 5% with 20 µg versus 14% with placebo (relative risk 0.35) and non-vertebral fractures in 3% versus 6%. PubMed 11346808
Better than risedronate in severe osteoporosis. VERO trial with 1,360 women over 2 years: new vertebral fractures in 5.4% with teriparatide versus 12.0% with risedronate, and clinical fractures in 4.8% versus 9.8%. PubMed 29129436

References

Information, not medical advice. Prescription or unapproved peptides should only be used under medical supervision.