Teriparatide
also known as Forteo, PTH (1-34), rhPTH(1-34), parathyroid hormone (1-34)
Recombinant 1-34 fragment of human parathyroid hormone, FDA-approved (Forteo, 2002) for severe osteoporosis, glucocorticoid-induced osteoporosis, and hypoparathyroidism. Daily subcutaneous administration stimulates osteoblast-mediated bone formation, increasing bone mineral density at spine and hip. Anabolic effect wanes after 12-18 months due to receptor desensitization, depletion of bone-forming surfaces, and upregulation of endogenous Wnt antagonists.
At a glance
SQ · Thigh/Abdomen · Once Daily
Primary target — Parathyroid hormone 1 receptor (PTH1R) on osteoblasts [xue-2026].
Pathway — PTH1R activation → cAMP/PKA signaling → osteoblast differentiation and activity.
Downstream effect — Stimulates osteoblast formation and bone matrix deposition; increases bone mineral density at trabecular and cortical sites.
Origin — Recombinant 34-amino-acid N-terminal fragment of 84-amino-acid human PTH.
Feedback intact — Yes — intermittent dosing preserves anabolic effect; continuous exposure causes catabolic bone resorption.
| Parameter | Value |
|---|---|
| Standard dose (osteoporosis) | 20 mcg / dayFDA-approved regimen for severe osteoporosis. |
| Frequency | Once dailyIntermittent administration preserves anabolic effect. |
| Maximum duration | 24 months lifetimeAnabolic effect wanes after 12-18 months; FDA recommends max 2-year cumulative exposure. |
| Hypoparathyroidism dose | 20 mcg / dayUsed off-label for chronic hypoparathyroidism. |
| Evidence basis | RCT / FDA-approved |
| Pelvic fragility fractures | 20 mcg / day × 8-12 weeksAccelerates fracture healing; reduces time to union. [crooks-2026] |
| Route | Subcutaneous (thigh or abdomen) |
| Timing | Morning or evening (flexible) |
| Storage | Refrigerate 2-8 °C; pen device stable at room temp for 28 days after first use |
| Pharmacogenetics | ALDH2 polymorphisms may influence BMD response [obara-2026]ALDH2*2 variant carriers show altered PTH receptor expression. [obara-2026] |
Reconstitution
A pure mass-to-volume utility. Enter what you have in the vial; the atlas computes the volume per dose. No prescription information.
Not indicated for fat loss; anabolic bone agent only.
| Outcome | Finding |
|---|---|
| Fat loss application | None — teriparatide is a bone anabolic agent without direct lipolytic activity |
- — Paget's disease of bone (increased baseline osteosarcoma risk)
- — Unexplained elevated alkaline phosphatase
- — Prior skeletal radiation therapy
- — Skeletal malignancies or bone metastases
- — Hypercalcemic disorders (primary hyperparathyroidism)
- — Pregnancy / lactation
- — Active or recent nephrolithiasis
- — Severe renal impairment (CKD G4-G5)
- — Hypercalciuria without adequate monitoring
- 01Device preparation
Teriparatide is supplied in pre-filled pen injectors (Forteo pen). Store refrigerated at 2-8 °C until first use. After first injection, pen may be kept at room temperature for up to 28 days. Do not freeze.
- 02Injection site
Subcutaneous injection into thigh or lower abdomen. Rotate sites daily to avoid lipodystrophy. Avoid areas with scars, bruises, or active skin conditions.
- 03Timing
Once daily, at approximately the same time each day. Morning or evening administration is acceptable. Take while sitting or lying down to minimize orthostatic hypotension risk.
- 04Injection technique
Clean injection site with alcohol swab. Pinch skin, insert needle at 90° angle, and inject full dose (20 mcg). Hold for 5 seconds before withdrawing needle. Do not rub injection site.
- 05Monitoring
Baseline and periodic monitoring of serum calcium, urinary calcium, serum PTH (if hypoparathyroidism), and bone mineral density (DXA scan). Monitor for hypercalcemia 4-6 hours post-dose if symptomatic.
- 06Calcium and vitamin D supplementation
Ensure adequate calcium (1000-1200 mg/day) and vitamin D (800-1000 IU/day) intake unless contraindicated by hypercalcemia or hypercalciuria.
Sources
of 62 rendered claims carry a resolvable citation.
- [crooks-2026]Crooks 2026 — Parathyroid Hormone in the Management of Pelvic Fragility Fractures: A Systematic Review and Meta-Analysis.
journal, 2026 - [ferrari-2026]Ferrari 2026 — Mechanisms Underlying the Waning of Osteoanabolic Therapy Effects in Osteoporosis.
journal, 2026 - [morrison-2026]Morrison 2026 — Anabolic effect of parathyroid hormone (1-34) to prevent ovariectomy induced bone loss is attenuated in Col1A1-cre floxed monocyte chemotactic protein 1 (MCP1, CCL2) mice.
journal, 2026 - [obara-2026]Obara 2026 — Effect of genetic polymorphisms of aldehyde dehydrogenase 2 on the efficacy of intermittent parathyroid hormone treatment and bone mineral density: A retrospective multicenter study.
journal, 2026 - [tournis-2026]Tournis 2026 — Approach to the Patient: Management of bone fragility in patients with chronic hypoparathyroidism.
journal, 2026 - [xue-2026]Xue 2026 — Nutritional activation of the Nrf2-Pth1r axis by pyrroloquinoline quinone enhances peak bone mass and potentiates teriparatide in osteoporosis.
journal, 2026