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Teriparatide (PTH(1-34))

Parathyroid hormone analogue

Also known as PTH(1-34), Forteo, Forsteo

A parathyroid hormone fragment approved for severe osteoporosis. The clearest case in this catalogue of a hormone whose effect reverses depending on how it is administered.

Guide updated Sep 2, 2026Literature checked Sep 2, 20261 curated study51 literature recordsBaseline editorial
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Overview

In shortThe active front end of parathyroid hormone, approved for osteoporosis in people at high risk of fracture. It earns a place here for one lesson worth internalising: this hormone kept constantly high destroys bone, while the same hormone given as a single daily pulse builds it. Same molecule, same receptor, opposite result, decided entirely by the pattern of exposure.

Teriparatide is the first 34 amino acids of human parathyroid hormone, approved for osteoporosis at high fracture risk.

It earns a place here for a mechanistic reason worth internalising: continuously elevated parathyroid hormone causes bone loss, while the same hormone given as a once-daily pulse causes bone formation. Same molecule, same receptor, opposite outcome, determined entirely by the pattern of exposure. Anyone reasoning from "this peptide does X" to "more of it does more X" should sit with that.

Mechanism

In shortIt binds a receptor on the cells that build bone. Given in short daily bursts it keeps those cells alive and working, so bone is built. Left constantly high, as happens in some diseases, the balance flips to the cells that break bone down. This is the textbook case of timing mattering as much as dose, and why how long a drug lasts is not the same as how long its effect lasts.

Teriparatide binds the PTH1 receptor on osteoblasts. Intermittent exposure favours osteoblast survival and activity, producing net bone formation. Continuous exposure, as in hyperparathyroidism, shifts the balance toward osteoclastic resorption and net bone loss.

This is the canonical example of pattern-dependent pharmacology, and it is the reason "half-life is not duration of effect" matters beyond pedantry.

Evidence

In shortEstablished. The main trial reported substantially fewer new fractures in postmenopausal women who had already had one, and it was stopped early when tumours turned up in rats. Later evidence supports use in men and in bone loss caused by steroids. How long you can take it is capped by the label, and the gains are lost after stopping unless another drug follows it.

Established. The pivotal Fracture Prevention Trial reported substantial reductions in new vertebral and non-vertebral fractures in postmenopausal women with prior vertebral fracture, and the trial was stopped early when rodent osteosarcoma findings emerged.

Subsequent evidence supports use in men and in glucocorticoid-induced osteoporosis. Treatment duration is limited by labelling, and bone density gains are lost after discontinuation unless followed by an antiresorptive agent.

Safety

In shortCommon effects are nausea, headache, dizziness and leg cramps, and blood calcium rises briefly. A bone tumour signal in rats led to a boxed warning and a lifetime limit on total treatment. Long-term human monitoring has not reproduced it at the expected rate and some countries have relaxed the label, but it is a good illustration of how one rodent finding can constrain a drug for twenty years.

Common effects include nausea, headache, dizziness, and leg cramps. Transient hypercalcaemia occurs.

The osteosarcoma signal from rat carcinogenicity studies drove a boxed warning and a cumulative lifetime duration limit. Long-term human surveillance has not reproduced it at the expected rate, and labelling has been relaxed in some jurisdictions, but the history is a good illustration of how a rodent finding can constrain a drug for two decades.

Contraindicated with pre-existing hypercalcaemia, skeletal malignancy, or prior skeletal radiation.

Regulatory status

In shortApproved widely for osteoporosis in people at high fracture risk. Prescription only, with limits on how long you can take it. Cheaper equivalents are available in several markets.

Approved widely for osteoporosis at high fracture risk. Prescription-only, with defined duration limits. Biosimilars are available in several markets.

The literature

1 study indexed. Findings and limitations get equal weight, on purpose.

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The wider literature

14 indexed papers and 37 registered trials mentioning Teriparatide, straight from PubMed and ClinicalTrials.gov. 35 of 37 administer it; the rest measure it. These have not been read by us. Unlike the studies above, they carry no findings and no limitations written by anyone here, because writing either would mean claiming a reading nobody has done. They are a starting point for yours.

Registered trials (37)

  1. Bone Turnover Markers and Treatment Efficacy in Postmenopausal Osteoporosis

    Khyber Medical University Peshawar2025NCT07242612

    interventionalnacompletedn=40

  2. Sequential Therapies After Osteoanabolic Treatment

    424 General Military Hospital2023NCT06164795

    observationalrecruitingn=150

  3. Assess Safety and Compare PK of New Oral hPTH(1-34) Tablet Formulations vs. EBP05 Tablets and Subcutaneous Forteo

    Entera Bio Ltd.2023NCT05965167

    interventionalphase1completedn=45

  4. Treatment of Adynamic Bone Disorder With Parathyroid Hormone in Chronic Kidney Disease

    Ditte Hansen2021NCT04522622

    interventionalphase4recruitingn=48

  5. Circulating Myokine Levels and Bone Metabolism

    424 General Military Hospital2019NCT04206618

    observationalcompletedn=220

  6. G56W1 in Women With Postmenopausal Osteoporosis

    Shenzhen Salubris Pharmaceuticals Co., Ltd.2018NCT03720886

    interventionalphase1phase2unknownn=148

  7. Ankle Fractures Treated With Teriparatide

    Nottingham University Hospitals NHS Trust2016NCT02955056

    interventionalphase4unknownn=10

  8. One Week Comparison Study of PTH and PTHrP Infusions

    University of Pittsburgh2015NCT01333267

    interventionalphase1withdrawnn=0

  9. Denosumab for Prevention of Post-Teriparatide Bone Loss in Premenopausal Women With IOP

    Elizabeth Shane2014NCT02049866

    interventionalphase2completedn=33

  10. A Pilot Study to Evaluate the Effect of Forsteo (Teriparatide, 1-34-rh-PTH) in Anorexia Nervosa Patients With Low Bone Mineral Density and Increased Bone Fagility (FAN-Trial)

    University of Zurich2014NCT01801397

    interventionalphase3unknownn=10

  11. Nasally and sc Administered Teriparatide in Healthy Volunteers

    Nottingham University Hospitals NHS Trust2013NCT01913834

    interventionalphase1unknownn=7

  12. Effect of Teriparatide on Fracture Healing in Patients With Incomplete Atypical Femur Fractures

    University Health Network, Toronto2013NCT01896011

    interventionalphase3completedn=34

  13. A Study to Assess the Safety, Pharmacokinetics and Pharmacodynamics of Oral PTH (1-34) Formulations in Healthy Subjects

    Entera Bio Ltd.2013NCT02571140

    interventionalphase1completedn=30

  14. Stem Cell Recruitment in Osteoporosis Therapy

    Johns Hopkins University2012NCT01656629

    interventionalnaterminatedn=55

  15. Pharmacodynamics, Pharmacokinetics, Safety and Tolerability of PTH Analog Tablets in Postmenopausal Women

    Unigene Laboratories Inc.2011NCT01321723

    interventionalphase2completedn=97

  16. The Impact of Parathyroid Hormone (PTH) on Craniofacial Osseous Regeneration in Bone

    University of Michigan2011NCT01279187

    interventionalphase2terminatedn=27

  17. Teriparatide Treatment in Patients With Inherited Osteoporosis

    Helsinki University Central Hospital2011NCT01360424

    interventionalphase4completedn=6

  18. Denosumab, Teriparatide or Both for the Treatment of Postmenopausal Osteoporosis

    Massachusetts General Hospital2009NCT00926380

    interventionalphase2completedn=94

  19. Comparison Study of PTHrP and PTH to Treat Osteoporosis

    University of Pittsburgh2009NCT00853723

    interventionalphase2completedn=105

  20. Effects of Teriparatide or Zoledronic Acid Treatment on Bone in Postmenopausal Osteoporotic Women

    Eli Lilly and Company2009NCT00927186

    interventionalphase4completedn=69

  21. Study of the Experience of Patients With Osteoporosis Using the Forteo B Pen to Self Administer Once Daily Teriparatide Therapy

    Eli Lilly and Company2008NCT00577863

    interventionalphase3completedn=200

  22. Back Pain in Patients With Severe Osteoporosis

    Eli Lilly and Company2008NCT00761332

    observationalcompletedn=650

  23. µMRI of Therapeutic Intervention in Postmenopausal Osteoporosis

    University of Pennsylvania2008NCT01153425

    interventionalphase4completedn=33

  24. A Study for Teriparatide in Severe Osteoporosis

    Eli Lilly and Company2008NCT00696644

    observationalcompletedn=794

  25. Use of Teriparatide to Accelerate Fracture Healing

    University of Rochester2008NCT00594906

    interventionalnaterminatedn=10

  26. Teriparatide (PTH) and Bone Strength in Postmenopausal Women

    University Health Network, Toronto2008NCT01155245

    observationalactive not recruitingn=60

  27. A Phase II Study Evaluating SB-751689 in Post-Menopausal Women With Osteoporosis.

    GlaxoSmithKline2007NCT00471237

    interventionalphase2terminatedn=564

  28. Dose Ranging Study - Macroflux Parathyroid Hormone (PTH) in Postmenopausal Women With Osteoporosis

    Zosano Pharma Corporation2007NCT00489918

    interventionalphase2completedn=165

  29. The Effects of Ibandronate or Teriparatide Therapy on Bone Histology and Biochemical Indices in Patients on Hemodialysis With Low Bone Mineral Density

    Papageorgiou General Hospital2006NCT00446589

    interventionalphase4terminatedn=19

  30. The Effects of Therapy With Teriparatide on Vascular Compliance and Osteoprotegerin/RANKL

    Leland Graves III, MD2006NCT00347737

    interventionalnawithdrawnn=0

  31. A Pilot Methodology Study To Evaluate Changes In Bone Quality Parameters Following Therapy With Forteo

    Pfizer2006NCT00365924

    interventionalnacompletedn=20

  32. Bone Properties in Hypoparathyroidism: Effects of PTH

    John P. Bilezikian2004NCT00473265

    interventionalphase2phase3completedn=68

  33. Effects of Teriparatide on Distal Radius Fracture Healing

    Eli Lilly and Company2004NCT00190944

    interventionalphase2completedn=105

  34. Study of FORTEO Use in Subjects in the Community Setting

    Eli Lilly and Company2003NCT01078805

    observationalcompletedn=4167

  35. Bone Effects of Teriparatide Following Alendronate

    Eli Lilly and Company2003NCT00191893

    interventionalphase3completedn=66

  36. PTH Comparison in Post Menopausal Women

    Eli Lilly and Company2002NCT00543218

    interventionalphase3completedn=63

  37. The Forteo Alendronate Comparator Trial

    Eli Lilly and Company2001NCT02416271

    interventionalphase4completedn=203

Papers (14)

  1. Oral daily PTH(1-34) tablets (EB613) in postmenopausal women with low BMD or osteoporosis: a randomized, placebo-controlled, 6-month, phase 2 study.

    Tripto-Shkolnik L, et al.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research2024PMID 38578978

    journal articlerandomized controlled trialclinical trial, phase iiresearch support, non-u.s. gov't

  2. An injectable liposome-anchored teriparatide incorporated gallic acid-grafted gelatin hydrogel for osteoarthritis treatment.

    Li G, et al.Nature communications2023PMID 37258510

    journal articleresearch support, non-u.s. gov't

  3. Parathyroid hormone and its related peptides in bone metabolism.

    Chen T, et al.Biochemical pharmacology2021PMID 34224692

    journal articleresearch support, non-u.s. gov'treview

  4. Abaloparatide and the Spine: A Narrative Review.

    Thompson JC, et al.Clinical interventions in aging2020PMID 32636617

    journal articlereview

  5. Denosumab, raloxifene, romosozumab and teriparatide to prevent osteoporotic fragility fractures: a systematic review and economic evaluation.

    Davis S, et al.Health technology assessment (Winchester, England)2020PMID 32588816

    journal articlenetwork meta-analysisresearch support, non-u.s. gov'tsystematic review

  6. Drugs for postmenopausal osteoporosis.

    The Medical letter on drugs and therapeutics2020PMID 32728009

    journal articlereview

  7. Teriparatide-induced atrial tachycardia.

    Ziffra JB Jr, et al.BMJ case reports2018PMID 29487102

    case reportsjournal article

  8. [Hypoparathyroidism].

    Koschker AC, et al.Deutsche medizinische Wochenschrift (1946)2015PMID 26261924

    english abstractjournal articlereview

  9. Biological agents in management of osteoporosis.

    Tella SH, et al.European journal of clinical pharmacology2014PMID 25204309

    journal articleresearch support, n.i.h., extramuralresearch support, non-u.s. gov'tresearch support, u.s. gov't, non-p.h.s.review

  10. Arrestins in bone.

    Bohinc BN, et al.Progress in molecular biology and translational science2013PMID 23764060

    journal articleresearch support, n.i.h., extramuralresearch support, non-u.s. gov'treview

  11. Teriparatide.

    2006PMID 35442604

    review

  12. Teriparatide (Forteo) for osteoporosis.

    Bazaldua OV, et al.American family physician2004PMID 15117021

    journal article

  13. Recombinant human PTH 1-34 (Forteo): an anabolic drug for osteoporosis.

    Deal C, et al.Cleveland Clinic journal of medicine2003PMID 12882381

    journal articlereview

  14. Teriparatide (forteo) for osteoporsis.

    The Medical letter on drugs and therapeutics2003PMID 12571538

    clinical trialjournal articlerandomized controlled trial

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For Research & Educational Discussion Only. Not Medical Advice

This guide is educational reference material compiled from published literature. It is not medical advice, not a recommendation, and not a substitute for a clinician who knows your history. Nothing here should be used to make a decision about your own health without one.

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