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Teriparatide (Forteo; recombinant human PTH(1-34))
A 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.
Prescription medication — not a dietary supplement
Teriparatide 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
Teriparatide 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 1997–2026 with a typical study size of 428 participants.
Based on 307 studies · 47 meta-analyses · 227 RCTs · 2,814 total participants
Confidence
High confidenceBy outcome
An FDA-approved anabolic drug with high-quality RCT evidence cutting vertebral and nonvertebral fractures, though it is a prescription daily injection, not a supplement, and doesn't accelerate fresh-fracture healing.
236 randomised trials
96% were about Teriparatide in an audit of 50 of them
Every randomised or controlled trial of Teriparatide 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
17 trials ongoing or recruiting · 125 completed on ClinicalTrials.gov
56 of the completed trials have posted results
Registered trials show research momentum for Teriparatide, 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
Teriparatide (brand name Forteo/Forsteo) is recombinant human parathyroid hormone (1-34) — the biologically active N-terminal 34-amino-acid fragment of the body's own 84-amino-acid PTH, produced by recombinant DNA technology.
It was the first anabolic (bone-building) osteoporosis drug, approved by the FDA in 2002, and is given as a 20 microgram once-daily subcutaneous injection.
Its mechanism is distinctive: continuous high PTH (as in hyperparathyroidism) drives bone loss, but intermittent once-daily PTH(1-34) does the opposite — binding the PTH1 receptor on osteoblasts and stimulating bone formation more than resorption, so that new bone is laid down and bone mineral density (BMD) rises.
Unlike the grey-market 'research peptides' it is sometimes grouped with, teriparatide has a real, high-quality evidence base.
The pivotal Fracture Prevention Trial (Neer et al., NEJM 2001; n=1637 postmenopausal women with prior vertebral fractures) found that 20 microg/day reduced new vertebral fractures from 14% on placebo to 5% (relative risk 0.35) and nonvertebral fragility fractures by roughly half (RR 0.47), while raising lumbar-spine BMD about 9 percentage points and femoral-neck BMD about 3 points more than placebo over a median 21 months.
The double-blind, double-dummy VERO head-to-head trial (Kendler et al., Lancet 2018; n=1360) directly compared teriparatide with the bisphosphonate risedronate in severe osteoporosis and found fewer new vertebral fractures (5.4% vs 12.0%; RR 0.44) and fewer clinical fractures (4.8% vs 9.8%) on teriparatide.
Efficacy extends beyond postmenopausal women: an RCT in men (Orwoll 2003) showed comparable BMD gains, and a head-to-head NEJM RCT in glucocorticoid-induced osteoporosis (Saag 2007) found teriparatide raised spine BMD more than alendronate.
Meta-analyses consistently rank teriparatide above bisphosphonates for BMD gain and fracture reduction in bisphosphonate-naive patients.
The fracture-HEALING literature (as opposed to fracture PREVENTION) is weaker and mixed — some meta-analyses suggest faster union after atypical femoral or vertebral fractures, but a meta-analysis of fresh-fracture healing found no clear benefit.
The most important honesty caveats: (1) this is a prescription drug, not a supplement — it is reserved for patients at high fracture risk and is not a general bone or anti-aging product; (2) it must be injected daily; (3) it can cause transient hypercalcemia and orthostatic (postural) hypotension; (4) it originally carried an FDA boxed warning for osteosarcoma and a 2-year lifetime-use cap, both driven by an excess of osteosarcomas in rats given high lifetime doses — but a 15-year US postmarketing surveillance study (Gilsenan, JBMR 2021) did not find an increased osteosarcoma incidence in treated adults, which does not establish zero risk.
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.
In the EU, Forsteo is contraindicated with metabolic bone disease other than primary or glucocorticoid-induced osteoporosis (including Paget’s disease and hyperparathyroidism), unexplained raised alkaline phosphatase, previous radiation therapy to the skeleton, and skeletal malignancy or bone metastases.
The US FORTEO label instead places osteosarcoma-risk groups under an avoid-use warning: open epiphyses, metabolic bone disease such as Paget’s disease, bone metastases or skeletal malignancy, skeletal radiation and hereditary predisposition.
Overall the evidence for its approved use — reducing fractures in high-risk osteoporosis — is genuinely Strong.
Teriparatide is the active N-terminal 1-34 fragment of parathyroid hormone. It binds the PTH/PTHrP type-1 (PTH1) receptor on osteoblasts and their precursors, the same receptor native PTH uses.
The key to its anabolic effect is timing. Continuously high PTH (as in hyperparathyroidism) drives net bone resorption, but a single daily subcutaneous pulse transiently activates the PTH1 receptor in a way that stimulates osteoblastic bone formation more than osteoclastic resorption — building new bone rather than breaking it down.
The net anabolic effect raises bone mineral density, most markedly at the trabecular-rich lumbar spine. In the pivotal trial lumbar-spine BMD rose about 9 percentage points and femoral-neck BMD about 3 points more than placebo over ~21 months; it can also repair underlying micro-architectural defects.
How Teriparatide 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, Forsteo is contraindicated with metabolic bone disease other than primary or glucocorticoid-induced osteoporosis (including Paget’s disease and hyperparathyroidism), unexplained raised alkaline phosphatase, previous radiation therapy to the skeleton, and skeletal malignancy or bone metastases. The US FORTEO label instead places osteosarcoma-risk groups under an avoid-use warning: open epiphyses, metabolic bone disease such as Paget’s disease, bone metastases or skeletal malignancy, skeletal radiation and hereditary predisposition.
Do not use. The EU Forsteo label says it should not be used under 18 or in young adults with open epiphyses, and the US FORTEO label says to avoid it with open epiphyses.
Use with caution and monitor urinary calcium.
Not studied — avoid.
Teriparatide can transiently raise serum calcium, which may predispose to digoxin toxicity; use caution.
Co-prescribed deliberately to supply substrate for bone formation, but combined with teriparatide's transient calcium rise, excessive supplementation could contribute to hypercalcemia — calcium should be monitored.
Tip: Usually transient and mild; monitor serum calcium, avoid extra calcium loading
Tip: Inject where you can sit or lie down for the first several doses
Tip: Usually self-limiting
Tip: Rotate injection sites
Tip: Monitor in patients with a history of kidney stones
Teriparatide has an evidence score of 7/10 — strong evidence based on 307 indexed studies, including 3 meta-analyses. A 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. Representative study: PMID 39312040.
The commonly studied dose of Teriparatide is 20 micrograms once daily by subcutaneous injection (the approved osteoporosis dose; PRESCRIPTION ONLY). Individual needs vary, so check the right dose for you with a healthcare provider.
Timing is flexible for Teriparatide — consistent daily use matters more than the time of day. Given as a single 20 microg subcutaneous injection once daily, into the thigh or abdomen, at a time of day the patient can sit or lie down if they feel dizzy.
Teriparatide should be used with caution — talk to a healthcare provider before taking it. Reported side effects include hypercalcemia (transient), orthostatic hypotension / dizziness, leg cramps. How often they occur is not established for all of them. Use caution if any of these apply to you: Osteosarcoma-risk conditions: in the EU (Forsteo) a contraindication with metabolic bone disease other than primary or glucocorticoid-induced osteoporosis (including Paget’s disease), unexplained raised alkaline phosphatase, previous radiation therapy to the skeleton, and skeletal malignancy or bone metastases. The US FORTEO label instead says to avoid use with open epiphyses, metabolic bone disease such as Paget’s disease, bone metastases or skeletal malignancy, skeletal radiation and hereditary predisposition; Pre-existing hypercalcemia or hyperparathyroidism; Active bone metastases or skeletal malignancy.
What side effects does Teriparatide have?Don't take this if…
Abaloparatide
Too few graded studiesA 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.
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 307 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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