Teriparatide (Forteo)

Teriparatide is used in post-menopausal woman and men who have osteoporosis and are at high risk for bone fractures. It is often used when other treatments fail or in severe forms of osteoporosis. Teriparatide itself builds bone and is different from other forms of osteoporosis treatment, which prevents bone breakdown.

How to Take It

Teriparatide is given by self -injection daily for two years maximum. The medication comes in a prefilled injector, which is like a pen. To inject the medicine, place the injector on the thigh or abdomen, push the button and the medication is automatically injected. The needle size is the same as an insulin needle. The injector has enough medicine for 28 days, and the medication should be kept refrigerated and be thawed to room temperature before giving yourself the injection.

Side Effects

Patients may get dizzy within four hours after taking the first few doses, but this goes away within a few hours. Occasionally, the injection site can become itchy, red, or swollen. Teriparatide rarely can cause increased levels of calcium in the blood, nausea, or achy joints.

Teriparatide has a black box warning, meaning the Food and Drug Administration is concerned with an increased risk of cancer. Osteosarcoma, a type of bone cancer, was found in rats that were given very large doses (3–60x human exposure of 20 mcg) of teriparatide. Repeat studies in monkeys did not reveal the risk of cancer. In a long-term cancer surveillance study involving over 75,000 patients from 2009–2019, no cases of osteosarcoma were identified.

Tell Your Rheumatology Provider

You should notify your rheumatology provider if you have trouble injecting yourself; if the injection site becomes red, itchy, warm, or swollen; or if you have increasing achy joints or muscle spasms.

Make sure to notify your other physicians while you are taking this drug. If you are pregnant or considering pregnancy, let your doctor know before starting this medication. Women should discuss birth control with their healthcare team as this medicine is not proven to be safe in pregnancy. It is unknown if teriparatide is present in breast milk and therefore it should be avoided in patients who are breast feeding.

Be sure to talk with your rheumatology provider before undergoing any surgeries while taking this medication.

Updated February 2024 by Mohammad Ursani, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis, and treatment of a medical or health condition.