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 the disease. Teriparatide itself builds bone and is different from other forms of osteoporosis treatment, which prevent 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 dose is 20 mcg (micrograms) a day and this is preset by the pen. 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 self-administration.

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 20mcg) of teriparatide. Repeat studies in monkeys did not reveal the risk of osteosarcoma. In a long term post marketing cancer surveillance study involving over 75K patients from 2009-2019, no incident cases of osteosarcoma were identified though conclusions could not be drawn due to a smaller than expected patient follow up time and the fact that no cases 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 primary care physicians or gynecologists. Breastfeeding should be avoided while taking teriparatide because the drug can enter breast milk.

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

Updated December 2021 by Mohammad Ursani, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee.

This information 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.

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