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Abaloparatide (Tymlos; synthetic PTHrP(1-34) analog)
A prescription anabolic (bone-building) osteoporosis drug — the medicine Tymlos — a synthetic analog of parathyroid-hormone-related peptide PTHrP(1-34), FDA-approved in 2017 for postmenopausal women at high fracture risk and later for men. Honest appraisal: unlike most peptides sold online, this one has a REAL pivotal phase-3 fracture RCT (ACTIVE) plus a sequential-therapy extension (ACTIVExtend) and several network meta-analyses — strong evidence for its narrow osteoporosis indication, with a slightly smaller trial base than its older sibling teriparatide. It is a daily subcutaneous injectable prescription drug, not a dietary supplement. It raises bone density and cuts vertebral and nonvertebral fracture risk, but it carries a HISTORICAL rat-based osteosarcoma signal (the current US label has no boxed warning but still advises against use for more than 2 years in a lifetime, and the EU label sets an 18-month maximum), causes hypercalcemia (less than teriparatide) and orthostatic dizziness, and must be obtained and supervised by a prescriber.
Prescription medication — not a dietary supplement
Abaloparatide is a prescription (or investigational) drug, not a supplement. It is included here for reference because people research and discuss it (often used off-label) — not as a recommendation. Take it only under a qualified clinician's supervision and only as prescribed; do not source it from grey-market vendors, where identity, purity, and dosing are unverified. The evidence below reflects its clinical trials.
What the evidence says
Abaloparatide doesn't have enough studies with structured effect-size data yet to pool a verdict. Browse the studies below for individual findings.
Most evidence is from high-quality meta-analyses and randomised trials published 2015–2026 with a typical study size of 23 participants.
Based on 78 studies · 21 meta-analyses · 31 RCTs · 23 total participants
Confidence
High confidenceBy outcome
A pivotal phase-3 fracture RCT plus extension and three network meta-analyses show robust osteoporosis fracture reduction, but it rests on one fracture trial and carries hypercalcemia and a historical rat-osteosarcoma signal.
31 randomised trials
97% were about Abaloparatide in an audit of 31 of them
Every randomised or controlled trial of Abaloparatide indexed in PubMed, not a hand-picked subset. Meta-analyses and systematic reviews are deliberately excluded from this count: most of them cover many compounds at once, so counting them would inflate it.
PubMed · as of Sep 2026
7 trials ongoing or recruiting · 14 completed on ClinicalTrials.gov
10 of the completed trials have posted results
Registered trials show research momentum for Abaloparatide, not proof of effect — a registration is a plan, and posted results are sponsor-reported, not peer-reviewed. They are never counted toward the evidence rating above.
Browse these trials on ClinicalTrials.govClinicalTrials.gov · as of Nov 2026
Abaloparatide (brand name Tymlos; development code BA058) is a synthetic 34-amino-acid analog of human parathyroid-hormone-related peptide, PTHrP(1-34).
It is an anabolic — bone-building — osteoporosis drug, one of only a small class of agents (alongside teriparatide and romosozumab) that stimulate new bone formation rather than merely slowing bone loss.
Mechanistically it selectively binds and activates the RG (transient-signaling) conformation of the parathyroid hormone type-1 (PTH1) receptor on osteoblasts; favoring the RG over the RØ conformation is thought to drive a more transient, formation-dominant signal that builds bone with proportionally less of the bone-resorbing response seen with PTH/teriparatide.
Critically — and unlike the grey-market 'research peptides' it is sometimes grouped with — abaloparatide is an FDA-approved prescription drug (approved April 2017) with a genuine pivotal trial.
The phase-3 ACTIVE RCT (JAMA 2016, n=2463 postmenopausal women) randomized to abaloparatide 80 µg/day, placebo, or open-label teriparatide for 18 months: new morphometric vertebral fractures fell ~86% and nonvertebral fractures fell significantly versus placebo, with larger bone-mineral-density (BMD) gains than placebo.
The ACTIVExtend study (JCEM 2018) showed that sequencing 24 months of alendronate after abaloparatide preserved and extended the benefit, with an 84% relative reduction in vertebral fracture over the full 43 months.
Head-to-head BMD data from ACTIVE found abaloparatide produced more BMD responders than teriparatide and better preserved cortical/forearm bone (numerically fewer wrist fractures). The ATOM trial (JBMR 2022, n=228 men) extended the indication to men, with large 12-month BMD gains.
Three network meta-analyses (BMJ 2023; ACP/Ann Intern Med 2023; Osteoporos Int 2025) consistently place abaloparatide and teriparatide as more effective than bisphosphonates for clinical and vertebral fractures, with the 2025 PTH1-agonist NMA suggesting abaloparatide has an edge over teriparatide for nonvertebral and hip fractures.
The honesty caveats: (1) the evidence base, while strong, rests on one pivotal fracture RCT plus extension and meta-analytic synthesis — fewer independent fracture trials than the longer-marketed teriparatide; (2) it is a prescription injectable, NOT a supplement, requiring a prescriber, daily subcutaneous self-injection, and periodic monitoring; (3) it carries a HISTORICAL osteosarcoma concern — chronic high-dose dosing in rats produced osteosarcomas comparably to PTH(1-34) (Regul Toxicol Pharmacol 2017), which underpinned an original US FDA boxed warning and a 2-year cumulative-use limit; the current US label has no boxed warning and says it is unknown whether abaloparatide causes osteosarcoma in humans, but it still says that use for more than 2 years during a patient's lifetime is not recommended, and it advises avoiding abaloparatide where baseline osteosarcoma risk is increased (open epiphyses, metabolic bone disease such as Paget's disease, skeletal malignancy or metastases, skeletal radiation, hereditary predisposition).
In the EU, Eladynos is limited to 18 months of treatment in total and is contraindicated with known osteosarcoma risk, including previous skeletal radiation, and with unexplained raised alkaline phosphatase, skeletal malignancy or bone metastases; (4) it causes dose-related hypercalcemia (though less than teriparatide) and orthostatic hypotension/dizziness, and raises uric acid; and (5) the anabolic effect is transient and treatment-dependent — benefit is consolidated by following the course with an antiresorptive.
Overall the evidence is Moderate-to-strong for osteoporosis fracture prevention in the approved populations, and essentially nonexistent for any off-label 'anti-aging' or general-bone use.
Abaloparatide is a synthetic PTHrP(1-34) analog that selectively binds and activates the RG (transient-signaling) conformation of the parathyroid hormone type-1 (PTH1) receptor. Favoring the RG over the RØ conformation produces a shorter, more transient receptor signal than PTH/teriparatide — thought to bias the response toward bone formation over resorption.
Intermittent (daily) PTH1-receptor stimulation activates osteoblasts and increases bone formation. In transiliac bone biopsies, 3 months of abaloparatide increased mineralizing surface and bone-formation rate on cancellous, endocortical, intracortical and periosteal surfaces, with a notable modeling-based (de novo) formation component.
The anabolic signal translates into measurable BMD gains at the lumbar spine, total hip and femoral neck within months. In the ACTIVE trial BMD increases were significantly greater than placebo at all sites, and a greater proportion of patients reached BMD response thresholds than with teriparatide.
How Abaloparatide works — from molecular targets to health outcomes. Click an edge to see supporting research.This visualization is in beta — pathways are being refined and expanded.
In the EU, Eladynos is contraindicated in people with known osteosarcoma risk, including previous radiation involving the skeleton, and in people with unexplained raised alkaline phosphatase, skeletal malignancy or bone metastases. The US TYMLOS label places osteosarcoma-risk groups under an avoid-use warning rather than its formal contraindications. The US list includes open epiphyses, metabolic bone disease such as Paget’s disease, skeletal malignancy or metastases, skeletal radiation and hereditary predisposition.
Not for use in pregnancy or breastfeeding — abaloparatide treats postmenopausal/older-adult osteoporosis and developmental safety is not established.
Use only under medical supervision with calcium monitoring; abaloparatide can raise serum calcium, with implications for stone risk and digoxin toxicity.
Off-label and outside the evidence base. The trials were exclusively in osteoporosis at high fracture risk; benefit and safety in healthy users are unproven and it is a prescription injectable drug.
Abaloparatide can transiently raise serum calcium; because hypercalcemia predisposes to digoxin toxicity, patients on digoxin should be monitored carefully.
Abaloparatide can cause orthostatic hypotension and dizziness, typically within hours of a dose; additive effects with blood-pressure-lowering agents may worsen lightheadedness. Inject where the patient can sit or lie down.
Anabolic osteoporosis agents are not combined; abaloparatide is used as a single anabolic course, then sequenced to an antiresorptive. Concurrent use is not supported by evidence.
Tip: Rotate abdominal injection sites; reactions are usually transient.
Tip: Take the first several doses sitting or lying down; rise slowly. Usually occurs within 4 hours of injection and resolves.
Tip: Often subsides over time; report persistent symptoms to the prescriber.
Tip: Monitor serum and urinary calcium; abaloparatide hypercalcemia was 3.4% vs 6.4% with teriparatide in ACTIVE. Caution in those prone to hypercalcemia or with active urolithiasis.
Tip: Generally not clinically significant; relevant in gout or hyperuricemia — monitor if predisposed.
Abaloparatide has an evidence score of 6/10 — moderate evidence based on 78 indexed studies, including 3 meta-analyses. A prescription anabolic (bone-building) osteoporosis drug — the medicine Tymlos — a synthetic analog of parathyroid-hormone-related peptide PTHrP(1-34), FDA-approved in 2017 for postmenopausal women at high fracture risk and later for men. Honest appraisal: unlike most peptides sold online, this one has a REAL pivotal phase-3 fracture RCT (ACTIVE) plus a sequential-therapy extension (ACTIVExtend) and several network meta-analyses — strong evidence for its narrow osteoporosis indication, with a slightly smaller trial base than its older sibling teriparatide. It is a daily subcutaneous injectable prescription drug, not a dietary supplement. It raises bone density and cuts vertebral and nonvertebral fracture risk, but it carries a HISTORICAL rat-based osteosarcoma signal (the current US label has no boxed warning but still advises against use for more than 2 years in a lifetime, and the EU label sets an 18-month maximum), causes hypercalcemia (less than teriparatide) and orthostatic dizziness, and must be obtained and supervised by a prescriber. Representative study: PMID 37130601.
Dosing for Abaloparatide: Approved regimen (Tymlos): 80 µg once daily by subcutaneous injection (abdomen), via a metered prefilled pen. This is a prescription drug — dose, duration and monitoring are set by a prescriber. The current US label still says that use for more than 2 years during a patient's lifetime is not recommended. There is no validated use outside osteoporosis fracture prevention. Individual needs vary, so check the right dose for you with a healthcare provider.
Timing is flexible for Abaloparatide — consistent daily use matters more than the time of day. The approved regimen is 80 µg subcutaneously once daily into the abdomen, rotating the injection site, independent of meals.
Abaloparatide should be used with caution — talk to a healthcare provider before taking it. Reported side effects include hypercalcemia / hypercalciuria (less frequent than with teriparatide), injection-site reactions (redness, pain, swelling, bruising), dizziness / orthostatic hypotension, palpitations, headache. How often they occur is not established for all of them. Use caution if any of these apply to you: Known osteosarcoma risk: in the EU (Eladynos) a contraindication with previous radiation involving the skeleton, unexplained raised alkaline phosphatase, skeletal malignancy or bone metastases. The US TYMLOS label instead says to avoid use in osteosarcoma-risk groups: open epiphyses, metabolic bone disease such as Paget’s disease, skeletal malignancy or metastases, skeletal radiation and hereditary predisposition; Pre-existing hypercalcemia or conditions predisposing to hypercalcemia; Pregnancy and breastfeeding (not for use).
What side effects does Abaloparatide have?Don't take this if…
Teriparatide
Too few graded studiesA prescription anabolic bone-building drug — the recombinant N-terminal fragment of human parathyroid hormone, PTH(1-34), sold as Forteo (Forsteo in the EU). Honest appraisal: this is one of the few peptides on this site with genuinely strong evidence. The pivotal 1637-woman NEJM trial (Neer 2001) cut new vertebral fractures by about two-thirds and nonvertebral fragility fractures by about half, and the head-to-head VERO trial beat risedronate for new vertebral fractures. It is NOT a supplement: it is an FDA-approved, daily subcutaneous injection reserved for osteoporosis patients at high fracture risk. It carried a US FDA boxed warning for osteosarcoma (based on rats) and a 2-year lifetime-use limit. The EU Forsteo label limits total treatment to 24 months and says that course should not be repeated during a patient’s lifetime. In November 2020, the FDA removed FORTEO’s osteosarcoma boxed warning. The US label now says treatment beyond two years in a lifetime should be considered only if the patient remains at, or returns to, high fracture risk.
Semaglutide
Too few graded studiesAn FDA-approved GLP-1 receptor agonist (Ozempic/Rybelsus for type 2 diabetes, Wegovy for chronic weight management) with genuinely strong, large-RCT evidence for glycemic control and substantial weight loss, plus a cardiovascular-outcomes benefit. Honest appraisal: this is a real prescription medicine with real efficacy AND real risks — a US FDA boxed warning for thyroid C-cell tumors, pancreatitis and gallbladder risk, very common GI side effects, and growing concern about grey-market/compounded versions. It is a prescription drug, not a supplement, and is never auto-recommended.
Tirzepatide
Too few graded studiesAn FDA-approved prescription medication (Mounjaro for type 2 diabetes, Zepbound for obesity and obstructive sleep apnea), not a dietary supplement. Honest appraisal: in head-to-head phase-3 trials it is the most effective approved weight-loss drug to date — up to ~21% body-weight loss over 72 weeks and superior to semaglutide — but it is a real medicine with real risks: a US FDA boxed warning for thyroid C-cell tumors, common GI side effects, and pancreatitis/gallbladder signals. Do not source or use it outside a prescription.
Liraglutide
Too few graded studiesAn FDA-approved, once-daily GLP-1 receptor agonist (Victoza for type 2 diabetes, Saxenda for chronic weight management). Honest appraisal: a real prescription medicine with genuinely strong large-RCT evidence for glycemic control and moderate weight loss, plus a cardiovascular-outcomes benefit (LEADER). It also carries real risks — a US FDA boxed warning for thyroid C-cell tumors, pancreatitis and gallbladder risk, very common GI side effects, and lean-mass loss with weight loss. It is a prescription medicine, NOT a supplement, and is not auto-recommended.
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Reviewed by Dr. Baher Al Hakim · Last reviewed June 2026 · evidence from 78 studies · how we score · editorial policy
This information is for educational purposes only. It is not a substitute for professional medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication.
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