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Bone & calcium

Teriparatide

A parathyroid-hormone fragment that builds bone — one of the few anabolic osteoporosis treatments.

L5Practice-changingApproved medicineApprovedHigh confidenceLast reviewed 2026-08-23
SC injection

Also known as: Forteo, PTH(1-34), teriparatide injection

Evidence passport

Last reviewed 2026-08-23

Evidence level
L5Practice-changing
Confidence
High confidence
Human efficacy
85/100
Human safety
80/100
Regulatory status
Approved medicine
Development
Approved
Routes
SC injection
Evidence base
Includes human data
Furthest stage
Approved
Source curation
Sources fully curated
Clinical maturity
Long-approved osteoporosis medicine

Overview

Human evidence85/100
Preclinical evidence80/100
Human safety evidence80/100

Clinical maturity: Long-approved osteoporosis medicine

Routes & formulations

Studied / approved routes

SC injection

Approved products are daily subcutaneous injections, with duration limits defined in labelling.

Route availability is not evidence of efficacy, and evidence from one route does not transfer to another. The Registry never provides dosing or sourcing information.

Peptide lifecycle

  1. Discovery

  2. Preclinical

  3. Phase I

  4. Phase II

  5. Phase III

  6. Approved

Approved

What it is

The first 34 amino acids of parathyroid hormone — the fragment containing its receptor activity — given intermittently to stimulate new bone formation.

What people claim

  • Reduces fracture risk in high-risk osteoporosis
  • Builds new bone rather than only slowing loss

What the evidence actually says

Randomised trials demonstrated fracture-risk reduction in defined high-risk populations. The intermittent-dose paradox is mechanistically famous here: continuous PTH erodes bone, while brief daily pulses build it.

Human evidence

  • Pivotal randomised trials showing vertebral and non-vertebral fracture reduction.

Preclinical evidence

  • Bone-formation pharmacology.
  • Rat studies showed osteosarcoma at high, near-lifetime exposures — the origin of treatment-duration limits.

Animal and cell findings are Level 1–2 evidence.

Mechanism and pathways

  • Intermittent PTH1-receptor activation preferentially stimulates osteoblast activity and bone formation.

Safety and unknowns

  • Labelled duration limits exist because of the rat osteosarcoma signal.
  • Labelled effects include transient hypercalcaemia, dizziness and leg cramps.

Cancer relevance

Monitored in trials; not demonstrated in humans

Rat studies found osteosarcoma at exposures far above human dosing, driving precautionary labelling. Post-marketing surveillance in humans has not established the same risk, but the precaution shapes how the drug is used.

Regulatory status

Approved for osteoporosis in patients at high fracture risk, with indications varying by label and region. Indication-specific.

Evidence grade

L5Practice-changingHigh confidence

Replicated large randomised trials, pivotal Phase 3 programmes, or a major regulatory decision.

What would change our rating?

  • Continued long-term human registry surveillance on the osteosarcoma question.

References and sources

Sources fully curated

Source hierarchy: regulatory documents and trial registries first, peer-reviewed work next, sponsor material flagged as non-independent. We never use supplier or clinic marketing as evidence, and where a verified source has not yet been curated we say so rather than inventing one.

Evidence change history

No recorded changes yet. Baseline position set on 2026-08-23.