Teriparatide

Dosing from the Literature

Published for bone healing: trial doses of 20 µg a day for 4 weeks to 18 months (40 µg a day for 8 weeks in one wrist-fracture trial), or 56.5 µg a week, in the healing trials on this page, of 13 to 224 people each, with mixed results. Not published: a label that lists a healing use, or trials that agree.

The table records the label dose and the doses each trial gave, with the people they were given to. Every row is an injection, daily or weekly; they are label and trial doses, not recommendations.

What It Is

Teriparatide is the first 34 amino acids of human parathyroid hormone (PTH), the 84-amino-acid hormone that regulates calcium and phosphate in bone and kidney: SVSEIQLMHNLGKHLNSMERVEWLRKKLQDVHNF (UniProt P01270; Forteo label). Forteo’s label calls it a recombinant human parathyroid hormone analog (PTH 1-34), made by a strain of E. coli modified by recombinant DNA technology, with the formula C181H291N55O51S2 and a molecular weight of 4,117.8 daltons (Forteo label). Some other US products are made differently: Bonsity’s label says its teriparatide is made by a strain of Pseudomonas fluorescens modified by recombinant DNA technology, the Teva and Apotex labels say theirs is made by chemical synthesis, and Amphastar’s label calls its product a synthetic analog (Bonsity, Teva, Apotex and Amphastar labels). It is a peptide drug given by injection; Lilly’s code for it was LY333334 (ClinicalTrials.gov NCT01473589).

The label gives 1987 as teriparatide’s first US approval, and Drugs@FDA lists an older product, Parathar (teriparatide acetate, NDA 019498), as discontinued (Forteo label; Drugs@FDA). Lilly’s Forteo (NDA 021318) was approved on November 26, 2002 for osteoporosis (Drugs@FDA; Forteo label). Its pivotal trial, in 1,637 postmenopausal women, was stopped early when a long-term study found bone tumors (osteosarcoma) in rats, and Forteo was approved with a boxed warning about them and a label statement advising against use for more than 2 years in a lifetime (Krege et al., 2022). In November 2020 FDA removed the boxed warning and relaxed the two-year limit, after large US surveillance studies found no increase in osteosarcoma among users (Krege et al., 2022; Forteo label, November 2020).

Drugs@FDA also lists, all prescription only, Bonsity (NDA 211939, approved October 4, 2019), a teriparatide injection from Almaject (NDA 218771, June 4, 2024), and generic versions from Teva and Apotex (November 16, 2023) and Amphastar (December 12, 2025); FDA’s NDC Directory lists an authorized generic of Forteo as well (Drugs@FDA; NDC Directory, data of October 2, 2026). In the EU, Lilly’s Forsteo was authorised on June 10, 2003 and Teriparatide SUN in November 2022; seven biosimilars were authorised from January 2017 to April 2026, and six remain authorised: Qutavina, authorised in August 2020, was withdrawn that November (EMA medicines data, searched October 4, 2026). In Japan, daily 20 µg injections and a once-weekly 56.5 µg injection (Teribone, Asahi Kasei Pharma) are approved (Kumagai et al., 2020; Hagino et al., 2021). A skin patch and oral tablets of PTH(1-34) have been tested in Phase 2 osteoporosis trials (Cosman et al., 2010; Tripto-Shkolnik et al., 2024); Drugs@FDA lists only injections.

Healing trials in people followed animal work: in rats and monkeys, PTH(1-34) injections made fracture callus larger, stronger or quicker to mature (Andreassen et al., 1999; Alkhiary et al., 2005; Manabe et al., 2007). Lilly then sponsored trials in wrist fractures from 2004 and in hip fractures from 2009 (ClinicalTrials.gov NCT00190944, NCT00887354, NCT01473589). No label read for this page lists healing as a use, and bone-building drugs are sometimes prescribed off-label for fracture healing and spinal fusion (Kawaguchi, 2025).

PubMed returns 4,025 records for “teriparatide” (searched October 4, 2026); 3,055 carry the word in the title or abstract, and 286 are tagged as randomized controlled trials.

Mechanism of Action

The receptor and bone-cell findings below come from cells, mice, rats and monkeys; the label and two studies of 55 and 40 postmenopausal women add what was measured in people (Forteo label; Drake et al., 2010; Lindsay et al., 2007).

• PTH type 1 receptor (PTH1R) — Teriparatide binds the same high-affinity cell-surface receptors as the first 34 amino acids of the body’s PTH, with the same affinity, and has the same actions on bone and kidney (Forteo label). That receptor, PTH1R, is a family B G protein-coupled receptor that also carries the signal of PTH-related protein; it activates the Gαs/cAMP pathway and, by the review’s account, appears able to do so from inside the cell (endosomes) as well as from its surface (Gardella & Vilardaga, 2015).
• Daily pulses against constant exposure — Once-daily dosing stimulates new bone on trabecular and cortical surfaces by favoring osteoblasts, the bone-building cells, over osteoclasts, which break bone down; a continuous excess of the body’s own PTH, as in hyperparathyroidism, can stimulate breakdown more than formation (Forteo label). In monkeys, teriparatide improved trabecular microarchitecture and raised bone mass and strength (Forteo label).
• Formation markers first, resorption markers later (people) — In the label trials, the formation marker PICP peaked about 41% above baseline at 1 month, and bone-specific alkaline phosphatase rose by up to 45% in women and 23% in men; the resorption markers NTX and DPD rose afterwards (Forteo label).
• Osteoblast survival (mice; not seen in human biopsies) — Daily PTH injections in mice increased bone formation without increasing the production of new osteoblasts: PTH lengthened the life of mature osteoblasts by preventing their apoptosis, an effect the authors confirmed in rodent and human osteoblast cultures (Jilka et al., 1999). A human biopsy study found more osteoblast apoptosis with PTH(1-34), not less (Lindsay et al., 2007).
• Sclerostin and Wnt signaling (mice, rats, cells, people) — Sclerostin, an osteocyte protein, inhibits Wnt signaling and bone formation (Drake et al., 2010; Keller & Kneissel, 2005). PTH(1-34) lowered expression of its gene, SOST, in mice given it on the skull for 5 days, in rats after a single 80 µg/kg dose under the skin and in ovariectomized rats after 8 weeks of 5 µg/kg, and by 95% within 6 hours in osteoblast-like UMR-106 cells, mainly through cAMP/PKA (Keller & Kneissel, 2005). In 27 postmenopausal women given 40 µg of PTH(1-34) (Forteo) a day for 14 days, blood sclerostin fell 12.7%, while 28 control women showed no significant change (Drake et al., 2010).
• New bone in human biopsies — In iliac-crest biopsies from 27 postmenopausal women with osteoporosis given 50 µg of hPTH(1-34) a day under the skin for 1 month, bone formation rates on cancellous and endocortical surfaces were 4.5 and 5.0 times those of 13 control women, and 4 times higher on the outer (periosteal) surface (Lindsay et al., 2007). In the same biopsies, more bone formation came with more osteoblast apoptosis, not less, which the authors suggest may reflect faster turnover of the osteoblast population (Lindsay et al., 2007).
• Calcium and clearance (people) — After a 20 µg dose, blood calcium starts to rise at about 2 hours, peaks at 4–6 hours (median rise 0.4 mg/dL) and returns to baseline by 16–24 hours; the drug itself peaks at about 30 minutes, falls below measurable levels within 3 hours, and has a half-life of about 1 hour (Forteo label).

What the Research Shows

The results below are in rats and monkeys. The rat doses ran from 5 to 200 µg/kg a day; in the label’s rat studies, 30 µg/kg gave about 20 times the human exposure at 20 µg (Forteo label). The human studies are in the next section.

• Healing rat fractures — In rats with broken tibias, 200 µg/kg a day raised the breaking load of the fracture by 75% at 20 days and 175% at 40 days; 60 µg/kg a day had no effect at 20 days and raised it 132% at 40 days (Andreassen et al., 1999). In 270 rats with femoral fractures, 30 µg/kg a day under the skin increased the callus’s torsional strength, stiffness and mineral by day 21, both 5 and 30 µg/kg increased bone mineral by day 35, and the strength and density gains at 30 µg/kg were still present at day 84, seven weeks after the last dose (Alkhiary et al., 2005).
• Healing in monkeys — In 17 female cynomolgus monkeys aged 18–19 with a surgically cut femur, given 0.75 or 7.5 µg/kg under the skin twice a week from 3 weeks before the cut to 26 weeks after it, or assigned to a control group, every bone united; on the high dose the callus was smaller and more mineralized, and the healed bone’s ultimate stress and elastic modulus (the strength and stiffness of the bone material) were higher than in controls, though the whole bone’s structural strength did not differ between groups (Manabe et al., 2007).
• Bone tumors in rats — Fischer 344 rats, 60 of each sex per group, injected under the skin with 5, 30 or 75 µg/kg a day for 2 years developed osteosarcoma in 3, 21 and 31 males and 4, 12 and 23 females (Vahle et al., 2002). The label reports osteosarcoma at every dose, reaching 40–50% at the high dose, none in untreated rats, and in a second study tumors that depended on dose and duration and did not appear in mature rats given 5 µg/kg for 6 or 20 months (Forteo label).
• No bone tumors in monkeys — Ovariectomized monkeys, 30 per group, given 5 µg/kg a day under the skin for 18 months, most of them then followed for 3 years without treatment, developed no bone tumors; after 18 months, spine bone density and strength were 29% and 52% higher than in untreated ovariectomized monkeys, the spine gains were gone 3 years after stopping, and some hip gains remained (Vahle et al., 2008).

Human Data

Below are the label’s three trials and two later fracture-prevention trials, of 428 to 1,637 people (Saag et al., 2007; Neer et al., 2001), then 15 randomized trials of teriparatide for healing a fracture or another bone or tendon repair, of 13 to 224 people each, found in PubMed searches of October 4, 2026, with the pooled analyses. The largest of the 15, in 224 people, had spine bone density as its primary endpoint (Malouf-Sierra et al., 2017). They are not every published trial: a 2026 review counted 28 randomized trials of osteoporosis drugs in adults with fractures, teriparatide among them (Agarwal et al., 2026), and a 2021 pooled analysis included Lilly’s 18-month trial in 712 postmenopausal women with back pain likely due to spine fractures, whose main outcome, a fall of 30% or more in worst back pain at 6 months, was reached by 59% on teriparatide and 57% on risedronate; new spine fractures were fewer on teriparatide, 4% against 9% (Eastman et al., 2021; Hadji et al., 2012; ClinicalTrials.gov NCT00343252).

For osteoporosis, the approved use:

• Postmenopausal women, 1,637 (Neer et al., 2001) — Women with earlier vertebral fractures injected 20 or 40 µg or placebo daily and were observed for a median 21 months. New vertebral fractures: 14% on placebo, 5% on 20 µg and 4% on 40 µg (relative risks 0.35 and 0.31); new nonvertebral fragility fractures: 6% against 3% in each dose group. The 40 µg dose raised bone density more but prevented no more fractures and was more likely to cause side effects. The trial was stopped early over the rat tumor finding (Krege et al., 2022). Lilly ran it as the pivotal trial of its application (FDA review, 2001).
• Men, 437 (Orwoll et al., 2003) — Men with low spine or hip bone density took 20 or 40 µg or placebo daily, with calcium and vitamin D; the trial stopped at a median 11 months because of the rat finding. Spine bone density rose 5.9% and 9.0% above baseline. Fractures were not its endpoint; the label approves teriparatide in men to increase bone mass (Forteo label). Lilly ran it, the trial in men among the four phase 3 trials in its application (FDA review, 2001).
• Glucocorticoid-induced osteoporosis, 428 (Saag et al., 2007) — For 18 months, women and men on long-term glucocorticoids took 20 µg teriparatide or 10 mg alendronate a day. Spine bone density rose 7.2% against 3.4%, and new vertebral fractures occurred in 0.6% against 6.1% (P = 0.004); nonvertebral fractures, 5.6% against 3.7%, did not differ significantly (P = 0.36). Lilly sponsored it (ClinicalTrials.gov NCT00051558).
• Against risedronate, 1,360 (Kendler et al., 2018) — VERO, double-blind, in postmenopausal women with severe osteoporosis, 24 months, 20 µg teriparatide daily against 35 mg risedronate weekly: among the 1,049 women with readable spine X-rays, new vertebral fractures in 5.4% (28 of 516) against 12.0% (64 of 533) (risk ratio 0.44; ClinicalTrials.gov NCT01709110); among all 1,360, clinical fractures in 30 against 61 women (hazard ratio 0.48) and nonvertebral fragility fractures in 25 against 38, not significant (P = 0.10). Lilly funded it.
• Weekly injections in Japan, 578 (Nakamura et al., 2012) — TOWER: 56.5 µg once a week or placebo for 72 weeks in patients aged 65–95 with an earlier vertebral fracture. New vertebral fractures: 3.1% against 14.5% (relative risk 0.20). Adverse events, and dropouts for adverse events, were more frequent on teriparatide.

For healing and repair, the use on this card:

• Wrist fractures, 102 women (Aspenberg, Genant et al., 2010) — Lilly’s Phase 2 (NCT00190944): postmenopausal women aged 45–85 with an angulated distal radius fracture set without surgery took placebo, 20 µg or 40 µg daily for 8 weeks, from within 10 days of the fracture. Median time to healing on X-ray was 9.1, 7.4 and 8.8 weeks. The planned main comparison, 40 µg against placebo, was not significant (p = .523); 20 µg against placebo was (p = .006), in a post hoc analysis the authors ask readers to interpret with caution. At one Swedish site, a blinded rating of 27 of these women 5 weeks after the fracture found “rich” callus in 9 (none on placebo) and “poor” callus in 9 (7 on placebo); the authors call it a post hoc subgroup outside the protocol (Aspenberg & Johansson, 2010).
• Femoral neck (hip) fractures, 159 (Bhandari et al., 2016) — Lilly ran two identical Phase 3 trials, designed to support approval of a new indication, of 20 µg daily or placebo for 6 months after screw fixation (NCT01473589, NCT01473602). Slow enrollment stopped both, and their 159 patients were pooled. Revision surgery within 12 months: 14% on placebo and 17% on teriparatide; radiographic healing at 12 months: 75% and 73%; pain did not differ. The authors call the results exploratory.
• Pertrochanteric (hip) fractures against risedronate, 224 (Aspenberg et al., 2016) — 20 µg daily against 35 mg risedronate weekly, double-blind for 26 weeks, from within 2 weeks of fixation; 171 of the 224 randomized were analyzed (mean age 77). The teriparatide group finished the Timed Up-and-Go test faster (p = 0.021 overall) and reported less pain after it at 12 and 18 weeks; radiographic healing, implant failure and loss of reduction (the fracture slipping out of position) did not differ, and no fracture failed to unite. Mild hypercalcemia and raised uric acid were more frequent on teriparatide. The walking test and pain were secondary endpoints and the X-ray outcomes exploratory ones. The trial’s primary endpoint, reported separately, was spine bone density after 78 weeks of treatment, the last 52 of them open-label: it rose 11.08% on teriparatide and 6.45% on risedronate (Aspenberg et al., 2016; Malouf-Sierra et al., 2017). Lilly funded the trial (ClinicalTrials.gov NCT00887354), and two of the authors were Lilly employees.
• Pertrochanteric fractures against placebo, 50 (Tanavalee et al., 2025) — A Thai double-blind trial (NCT03133195): 20 µg daily or saline from the second day after nail fixation, for 12 weeks. Radiographic union came at 7.44 ± 3.34 weeks against 10.56 ± 4.98 (p = 0.0083); hip scores and walking tests improved equally in both groups.
• Hip fractures, weekly injections (Lee et al., 2023) — A double-blind trial of 56.5 µg a week or saline in women aged 65 and over after hip-fracture surgery. Of 221 randomized, only the 92 who received injections for 3 months or more were analyzed (51 and 41). Healing scores (RUSH) were higher on teriparatide at 3 months (15.5 against 12.1) and 6 months (22.4 against 18.6); at 1 year they did not differ (p = 0.461).
• Shoulder (proximal humerus) fractures, 40 women (Johansson, 2016) — In postmenopausal women, 20 µg daily (Forteo) for 4 weeks, from within 10 days of the fracture, against no injection (NCT01105832); 39 completed. Blinded radiologists sorting callus as better or normal matched the treatment group in 21 of 39 cases, and pain and function did not differ at 7 weeks or 3 months.
• Pelvic fractures, 35 (Nieves et al., 2022) — Phase 2, double-blind (NCT02972424): 20 µg daily or placebo for 3 months, started within 4 weeks of the fracture; mean age 82, more than 80% women. Healed on CT at 3 months: 50% against 53%. Pain fell equally. Among the 28 who could do the tests, a combined physical-performance score (walking speed, chair stands, balance) was higher on teriparatide at 2 and 3 months (p < 0.03); the Timed Up and Go test did not differ between groups. Planned for 100 patients, it stopped early when the study-drug supply was withdrawn; Lilly provided drug and placebo.
• Jaw (mandible) fractures, 30 (Ebrahimi et al., 2022) — A single-blind trial of daily teriparatide (CinnoPar) for 1 month after surgical fixation, against none: bone repair and complications did not differ.
• Stress fractures, 13 women (Almirol et al., 2016) — A pilot in premenopausal women with lower-limb stress fractures: 20 µg (6 women) or placebo (7) for 8 weeks. Bone-formation markers rose more on teriparatide; on MRI, 83.3% against 57.1% had improved or healed (p = 0.18, not significant).
• Spinal fusion, two trials — In 75 women aged 50 and over with low bone density having lumbar interbody fusion, weekly teriparatide for 6 months after surgery, against none, gave higher fusion rates on CT at 4 months in an age-adjusted analysis and at 6 months per protocol (Ebata et al., 2017). In 87 older adults having fusion without implants for degenerative spondylolisthesis, 20 µg daily for 90 days did not change fusion rates or fusion mass against placebo (Jespersen et al., 2019).
• Rotator cuff repair (tendon to bone) — In a triple-blind trial in Tehran, 50 adults aged 50–80 took 20 µg (CinnoPar) or placebo daily for 3 months after arthroscopic repair; among the 43 analyzed, shoulder scores, motion, pain and re-tear rates (8.7% against 10%, p = 0.94) did not differ at 1 year (Guity et al., 2025). An earlier study, not randomized, gave 31 patients with tears over 2 cm 20 µg daily for 3 months and compared them with matched untreated patients: re-tears 16% against 33.9% (P = .04), function no different (Oh et al., 2019).
• Gum and jaw bone — In 40 patients with severe chronic periodontitis having surgery, 20 µg daily for 6 weeks with calcium and vitamin D, against placebo, gave a mean bone gain at 1 year of 29% against 3% (P < 0.001), with no serious adverse events; Lilly supplied the drug and had no role in the study (Bashutski et al., 2010). In 34 people with medication-related osteonecrosis of the jaw (47 lesions), given 20 µg daily or placebo for 8 weeks with calcium and vitamin D, lesions resolved at a greater rate on teriparatide (P = .013): by 52 weeks 45.4% had resolved, against 33.3% on placebo, and bone defects at 52 weeks were smaller (Sim et al., 2020).
• Knee replacement fixation, 50 (Ledin et al., 2017) — 20 µg daily (Forsteo) for 2 months after total knee replacement, against no treatment: implant migration from 12 to 24 months did not differ (median 0.14 against 0.13 mm).
• Pooled analyses and a dissent — A 2021 meta-analysis of randomized trials of PTH analogues in adults with fresh fractures found better function and no difference in the share of fractures healed at the first time point reported (four trials, 334 patients); its summary reports no reduction in pain, though pain was lower on treatment in the two trials it could pool (78 patients), a difference its authors call statistically significant but of questionable clinical relevance, and it did not analyze time to healing, writing that the estimates needed to calculate it limit their reliability (Eastman et al., 2021). A 2026 review found 28 randomized trials of osteoporosis drugs in 5,085 adults with fractures; pooling those it could, it found a shorter time to union with teriparatide than with control and no difference in delayed union, and its authors write that teriparatide “might reduce the time to union” (Agarwal et al., 2026). A 2025 review concludes that the bone-union effect claimed for teriparatide in fractures “has been refuted in clinical trials,” while it sped spinal fusion in patients with osteoporosis (Kawaguchi, 2025).

ClinicalTrials.gov lists 182 studies with teriparatide as an intervention, 17 of them with an active status, most in osteoporosis (searched October 4, 2026). Three concern repair: a placebo-controlled Phase 4 in US soldiers with tibial stress fractures, enrolling by invitation (NCT04589819); a pilot of 20 µg daily or placebo for 3 months after ankle-fracture surgery in adults aged 60 and over, not yet recruiting (NCT06303284); and a trial of 1 month of 20 µg before lumbar fusion, judged by the torque needed to insert the screws, whose primary completion was March 31, 2026, with no results posted (NCT03770338). Earlier healing trials with no results posted or published include a Swedish spinal-fusion trial of 34 patients completed in 2019 (NCT02090244) and a UK trial in army recruits with stress fractures, whose registry record was last updated in November 2020 and now shows its status as unknown; its protocol is published but no results (NCT04196855; Carswell et al., 2021).

The evidence meter on the Teriparatide card reads “Controlled trials”, not “Approved drug”: it counts published human data on teriparatide itself for the use its card is filed under, Tendon & gut repair (for teriparatide, bone healing), and teriparatide’s approval is for osteoporosis (Forteo label). For healing, randomized controlled trials are published, and their results are mixed (Eastman et al., 2021; Agarwal et al., 2026).

Reconstitution & Storage

There is nothing to reconstitute in the approved product: Forteo is a clear, colorless solution of 250 µg/mL in a prefilled pen that holds 560 µg in 2.24 mL and delivers 28 daily doses of 20 µg (Forteo label).

• Storage (label) — The label lists storage under refrigeration at 2–8 °C at all times except during injection, no freezing, and disposal of the pen 28 days after first use, even if solution remains (Forteo label).
• Pen only — The label says the pen’s contents are not to be transferred to a syringe, because that can give the wrong dose (Forteo label).
• Other forms — Parathar, the discontinued teriparatide acetate product, came as 200 units per vial (Drugs@FDA). A laboratory supplier lists “Synthetic Human Parathyroid Hormone Protein” (its catalogue address names PTH 1-34) as a reagent for research use only (searched October 4, 2026). No label or trial document read for this page gives reconstitution or storage steps for Parathar or the reagent, and no study has tested the reagent in people. FDA’s NDC Directory also lists teriparatide as a bulk ingredient, the active ingredient before it is made into a finished drug, from 12 labelers, one of them for export only (NDC Directory, data of October 2, 2026).

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Side Effects & Risks

• In the label trials — In 1,382 women and men in two placebo-controlled trials (median 19 and 11 months), serious adverse events occurred in 16% on teriparatide and 19% on placebo. Events more common on teriparatide included joint pain (10.1% against 8.4%), nausea (8.5% against 6.7%), dizziness (8.0% against 5.4%), leg cramps (2.6% against 1.3%) and fainting (2.6% against 1.4%) (Forteo label).
• Calcium and uric acid — Blood calcium went above normal at least once, 4–6 hours after a dose, in 11% of women and 6% of men, against 2% and 0% on placebo; uric acid went above normal in 3% against 1% (Forteo label). The label warns that teriparatide can cause hypercalcemia, advises against it in people with an underlying hypercalcemic disorder such as primary hyperparathyroidism, and reports calcium above 13 mg/dL since approval (Forteo label).
• Dizziness on standing — Transient symptomatic orthostatic hypotension occurred in 5% of healthy volunteers, beginning within 4 hours of a dose and within the first several doses; the label calls for the first doses to be given where the patient can sit or lie down (Forteo label).
• Bone tumors (osteosarcoma) — Rats given teriparatide developed osteosarcoma at every dose tested (Forteo label; Vahle et al., 2002). Cases have been reported in people since approval, but two US claims-based studies found 3 cases among 379,283 users and none among 153,316, and the label calls their data sources limited (Forteo label). In a 15-year US surveillance study, 3 of 1,173 interviewed osteosarcoma patients had used teriparatide before diagnosis, where 4.17 such cases were expected from background rates (standardized incidence ratio 0.72) (Gilsenan et al., 2021). Lilly funded that study, which RTI Health Solutions ran under contract as a commitment to FDA after approval, with the right to publish independently (Gilsenan et al., 2021). The label advises against teriparatide in people at higher baseline risk: open growth plates (children and young adults), Paget’s disease and other metabolic bone diseases, bone metastases or past skeletal cancer, past radiation to the skeleton, and inherited conditions that predispose to osteosarcoma; data beyond 2 years of use are limited (Forteo label).
• Allergic reactions and calciphylaxis — The current label lists anaphylaxis, angioedema and hives with PTH analogs including Forteo, and serious reports since approval of calciphylaxis and of worsening skin calcification, naming autoimmune disease, kidney failure, warfarin and systemic corticosteroids as risk factors (Forteo label).
• Kidney stones and digoxin — Kidney stones were as frequent as on placebo in the trials, but teriparatide was not studied in people with active stones; its brief rise in blood calcium may predispose people taking digoxin to digitalis toxicity (Forteo label).
• In the glucocorticoid trial — Among 428 patients, nausea (14% against 7%), gastritis (7% against 3%), pneumonia (6% against 3%), shortness of breath (6% against 3%), insomnia, anxiety and shingles were more frequent on teriparatide than on daily alendronate (Forteo label; Saag et al., 2007).
• In the healing trials — Over 6 months in the hip-fracture trials, adverse events were reported by 45% on teriparatide and 49% on placebo (Bhandari et al., 2016); mild hypercalcemia and raised uric acid were more frequent than on risedronate after pertrochanteric fractures (Aspenberg et al., 2016); the periodontal trial saw no raised serum calcium and no serious adverse events (Bashutski et al., 2010).
• Antibodies, pregnancy, breastfeeding, kidneys — Antibodies to teriparatide appeared in 3% of women (15 of 541) in the pivotal trial, without allergic reactions or loss of effect (Forteo label). There are no human pregnancy data; at doses more than 60 times the human dose, mouse offspring had more skeletal variations, and the label advises against use while breastfeeding (Forteo label). In 5 people with severe kidney impairment, drug exposure (AUC) rose 73% (Forteo label).
• Overdose — Medication errors in which a whole pen (up to 800 µg) was injected at once caused nausea, weakness and low blood pressure, with no deaths reported (Forteo label).
• WADA — Teriparatide is not named on the 2026 Prohibited List, and no section names parathyroid hormone or its analogues. Section S0 covers substances not addressed elsewhere on the List “with no current approval by any governmental regulatory health authority for human therapeutic use”; teriparatide is approved in the US, the EU and Japan, so S0 does not apply (World Anti-Doping Agency, 2026).

Bloodwork & Monitoring

Forteo’s label names these tests, and the healing trials measured others:

• Serum calcium — Calcium rises for a few hours after each dose; the trials measured it 4–6 hours after dosing, and in women whose levels stayed high, calcium supplements or the teriparatide dose were reduced (Forteo label).
• Urinary calcium — The label suggests measuring urinary calcium in people with high urinary calcium or suspected or known active kidney stones (Forteo label).
• Digoxin and overdose — The label notes watching for signs of digitalis toxicity in people taking digoxin, and checks of serum calcium and phosphorus after an overdose (Forteo label).
• What the healing trials measured — Bone turnover markers such as P1NP, osteocalcin and CTX, bone density by DXA, and healing on X-ray or CT scored by cortical bridging or the RUSH score (Almirol et al., 2016; Nieves et al., 2022; Lee et al., 2023).
• Which tests fit a given person — A question for a licensed healthcare provider. This page can’t answer it.

Commonly Stacked With

The label trials gave it on top of calcium and vitamin D (Forteo label). Several randomized trials have given it together with denosumab, among them DATA and DATA-HD in postmenopausal women with osteoporosis (Tsai et al., 2013; Tsai et al., 2019) and a trial in 16 patients with osteoporosis having lumbar fusion surgery, where the group also given denosumab had higher fusion rates at 6 months than the group on teriparatide alone (Ide et al., 2018). No study has tested it with BPC-157, TB-500, GHK-Cu, MK-677, ipamorelin, CJC-1295, sermorelin or tesamorelin (PubMed, searched October 4, 2026).

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Related Compounds

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References

1. Eli Lilly and Company. FORTEO (teriparatide injection), for subcutaneous use. Prescribing information, Medication Guide and User Manual (revised 8/2026; initial U.S. approval 1987). DailyMed set ID aae667c5-381f-4f92-93df-2ed6158d07b0, version 44 (effective August 3, 2026). dailymed.nlm.nih.gov. Read October 4, 2026.
2. Eli Lilly and Company. FORTEO (teriparatide injection) prescribing information, revised 11/2020. Recent Major Changes: “Osteosarcoma Boxed Warning, Removed 11/2020” and Recommended Treatment Duration (2.3). accessdata.fda.gov/drugsatfda_docs/label/2020/021318s054lbl.pdf. Read October 4, 2026.
3. U.S. National Library of Medicine. DailyMed prescribing information, section 11 (Description), for other US teriparatide products: BONSITY (teriparatide injection), Alvogen, set ID 2d0c89a2-3849-adf6-007d-aeca21cf417c, version 1 (revised 12/2024); Teriparatide Injection, USP, Teva, set ID d371f0f7-d492-4481-b360-051456d56d65, version 3 (effective September 1, 2024); Teriparatide injection, USP, Apotex, set ID d77d40db-7f38-88eb-fd5d-4282f0642028, version 10 (revised September 2026); Teriparatide injection, Amphastar, set ID d38b470a-2e62-487b-b3e7-134d3d1958b5, version 2 (effective December 22, 2025). dailymed.nlm.nih.gov. Read October 5, 2026.
4. U.S. Food and Drug Administration. Drugs@FDA records through openFDA: FORTEO, NDA021318 (Lilly; original approval November 26, 2002; prescription); BONSITY, NDA211939 (Alvogen; October 4, 2019); teriparatide, NDA218771 (Almaject; June 4, 2024); teriparatide, ANDA208569 (Teva) and ANDA211097 (Apotex), November 16, 2023; teriparatide, ANDA213641 (Amphastar), December 12, 2025; PARATHAR, teriparatide acetate 200 units/vial, NDA019498 (Sanofi Aventis US; discontinued); TYMLOS (abaloparatide), NDA208743 (Radius; April 28, 2017). api.fda.gov/drug/drugsfda.json. Read October 4, 2026.
5. U.S. Food and Drug Administration, Center for Drug Evaluation and Research. Orloff DG, Director, Division of Metabolic and Endocrine Drug Products. Memorandum to NDA 21-318, Forteo (teriparatide) injection, Eli Lilly & Company: NDA review issues and recommended action. October 1, 2001. In the Forteo approval package, medical review part 1 (scanned). accessdata.fda.gov/drugsatfda_docs/nda/2002/21-318_FORTEO_Medr_P1.pdf. Read October 5, 2026.
6. U.S. Food and Drug Administration. National Drug Code Directory (openFDA drug/ndc, data of October 2, 2026): teriparatide listings, including an NDA authorized generic of Forteo (Prasco, NDC 66993-495, marketing start November 17, 2023) and bulk-ingredient listings from 12 labelers, one of them (NDC 52416-126) marked export only. api.fda.gov/drug/ndc.json. Read October 4, 2026. FDA’s page on the directory says it holds finished and unfinished drugs, and that drug establishments must list the drugs they make for sale in the US, active pharmaceutical ingredients included (fda.gov/drugs/drug-approvals-and-databases/national-drug-code-directory). Read October 5, 2026.
7. European Medicines Agency. Medicines data (medicines-output-medicines_json-report): Forsteo (Eli Lilly Nederland, authorised June 10, 2003); biosimilars Terrosa (January 4, 2017), Movymia (January 11, 2017), Livogiva (August 27, 2020), Sondelbay (March 24, 2022), Kauliv (January 12, 2023) and Zandoriah (April 27, 2026), all authorised, and Qutavina (authorised August 27, 2020; withdrawn November 24, 2020); Teriparatide SUN (November 18, 2022). ema.europa.eu. Searched October 4, 2026.
8. UniProt Consortium. UniProtKB P01270 (PTHY_HUMAN), parathyroid hormone: precursor of 115 amino acids, mature chain 32–115; residues 32–65 are PTH(1-34). rest.uniprot.org. Read October 4, 2026.
9. Kumagai Y, Ose A, Tanaka K, Sugimoto T. Safety Profiles, Pharmacokinetics, and Changes in Bone Turnover Markers After Twice-Weekly Subcutaneous Administration of Teriparatide in Healthy Japanese Postmenopausal Women: A Single-Blind Randomized Study. Clin Pharmacol Drug Dev. 2020;9(1):87-96. PMID: 30921502. DOI: 10.1002/cpdd.687.
10. Hagino H, Sugimoto T, Tanaka S, et al. A randomized, controlled trial of once-weekly teriparatide injection versus alendronate in patients at high risk of osteoporotic fracture: primary results of the Japanese Osteoporosis Intervention Trial-05. Osteoporos Int. 2021;32(11):2301-2311. PMID: 34002252. DOI: 10.1007/s00198-021-05996-2.
11. Cosman F, Lane NE, Bolognese MA, et al. Effect of transdermal teriparatide administration on bone mineral density in postmenopausal women. J Clin Endocrinol Metab. 2010;95(1):151-158. PMID: 19858319. DOI: 10.1210/jc.2009-0358.
12. Tripto-Shkolnik L, Szalat A, Tsvetov G, et al. Oral daily PTH(1-34) tablets (EB613) in postmenopausal women with low BMD or osteoporosis: a randomized, placebo-controlled, 6-month, phase 2 study. J Bone Miner Res. 2024;39(6):672-682. PMID: 38578978. DOI: 10.1093/jbmr/zjae057.
13. Krege JH, Gilsenan AW, Komacko JL, Kellier-Steele N. Teriparatide and Osteosarcoma Risk: History, Science, Elimination of Boxed Warning, and Other Label Updates. JBMR Plus. 2022;6(9):e10665. PMID: 36111201. DOI: 10.1002/jbm4.10665.
14. Gardella TJ, Vilardaga JP. International Union of Basic and Clinical Pharmacology. XCIII. The parathyroid hormone receptors--family B G protein-coupled receptors. Pharmacol Rev. 2015;67(2):310-337. PMID: 25713287. DOI: 10.1124/pr.114.009464.
15. Jilka RL, Weinstein RS, Bellido T, et al. Increased bone formation by prevention of osteoblast apoptosis with parathyroid hormone. J Clin Invest. 1999;104(4):439-446. PMID: 10449436. DOI: 10.1172/JCI6610.
16. Keller H, Kneissel M. SOST is a target gene for PTH in bone. Bone. 2005;37(2):148-158. PMID: 15946907. DOI: 10.1016/j.bone.2005.03.018.
17. Drake MT, Srinivasan B, Mödder UI, et al. Effects of parathyroid hormone treatment on circulating sclerostin levels in postmenopausal women. J Clin Endocrinol Metab. 2010;95(11):5056-5062. PMID: 20631014. DOI: 10.1210/jc.2010-0720.
18. Lindsay R, Zhou H, Cosman F, et al. Effects of a one-month treatment with PTH(1-34) on bone formation on cancellous, endocortical, and periosteal surfaces of the human ilium. J Bone Miner Res. 2007;22(4):495-502. PMID: 17227219. DOI: 10.1359/jbmr.070104.
19. Andreassen TT, Ejersted C, Oxlund H. Intermittent parathyroid hormone (1-34) treatment increases callus formation and mechanical strength of healing rat fractures. J Bone Miner Res. 1999;14(6):960-968. PMID: 10352105. DOI: 10.1359/jbmr.1999.14.6.960.
20. Alkhiary YM, Gerstenfeld LC, Krall E, et al. Enhancement of experimental fracture-healing by systemic administration of recombinant human parathyroid hormone (PTH 1-34). J Bone Joint Surg Am. 2005;87(4):731-741. PMID: 15805200. DOI: 10.2106/JBJS.D.02115.
21. Manabe T, Mori S, Mashiba T, et al. Human parathyroid hormone (1-34) accelerates natural fracture healing process in the femoral osteotomy model of cynomolgus monkeys. Bone. 2007;40(6):1475-1482. PMID: 17369013. DOI: 10.1016/j.bone.2007.01.015.
22. Vahle JL, Sato M, Long GG, et al. Skeletal changes in rats given daily subcutaneous injections of recombinant human parathyroid hormone (1-34) for 2 years and relevance to human safety. Toxicol Pathol. 2002;30(3):312-321. PMID: 12051548. DOI: 10.1080/01926230252929882.
23. Vahle JL, Zuehlke U, Schmidt A, et al. Lack of bone neoplasms and persistence of bone efficacy in cynomolgus macaques after long-term treatment with teriparatide [rhPTH(1-34)]. J Bone Miner Res. 2008;23(12):2033-2039. PMID: 18684088. DOI: 10.1359/jbmr.080807.
24. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344(19):1434-1441. PMID: 11346808. DOI: 10.1056/NEJM200105103441904.
25. Orwoll ES, Scheele WH, Paul S, et al. The effect of teriparatide [human parathyroid hormone (1-34)] therapy on bone density in men with osteoporosis. J Bone Miner Res. 2003;18(1):9-17. PMID: 12510800. DOI: 10.1359/jbmr.2003.18.1.9.
26. Saag KG, Shane E, Boonen S, et al. Teriparatide or alendronate in glucocorticoid-induced osteoporosis. N Engl J Med. 2007;357(20):2028-2039. PMID: 18003959. DOI: 10.1056/NEJMoa071408. (NCT00051558.)
27. Kendler DL, Marin F, Zerbini CAF, et al. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet. 2018;391(10117):230-240. PMID: 29129436. DOI: 10.1016/S0140-6736(17)32137-2. (NCT01709110. PubMed links two 2018 Department of Error notices to it; their text was not available to this page.)
28. Nakamura T, Sugimoto T, Nakano T, et al. Randomized Teriparatide [human parathyroid hormone (PTH) 1-34] Once-Weekly Efficacy Research (TOWER) trial for examining the reduction in new vertebral fractures in subjects with primary osteoporosis and high fracture risk. J Clin Endocrinol Metab. 2012;97(9):3097-3106. PMID: 22723322. DOI: 10.1210/jc.2011-3479.
29. Gilsenan A, Midkiff K, Harris D, et al. Teriparatide Did Not Increase Adult Osteosarcoma Incidence in a 15-Year US Postmarketing Surveillance Study. J Bone Miner Res. 2021;36(2):244-251. PMID: 32990990. DOI: 10.1002/jbmr.4188.
30. Aspenberg P, Genant HK, Johansson T, et al. Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double-blind study of 102 postmenopausal women with distal radial fractures. J Bone Miner Res. 2010;25(2):404-414. PMID: 19594305. DOI: 10.1359/jbmr.090731. (NCT00190944.)
31. Aspenberg P, Johansson T. Teriparatide improves early callus formation in distal radial fractures. Acta Orthop. 2010;81(2):234-236. PMID: 20367417. DOI: 10.3109/17453671003761946.
32. Bhandari M, Jin L, See K, et al. Does Teriparatide Improve Femoral Neck Fracture Healing: Results From A Randomized Placebo-controlled Trial. Clin Orthop Relat Res. 2016;474(5):1234-1244. PMID: 26932738. DOI: 10.1007/s11999-015-4669-z.
33. Aspenberg P, Malouf J, Tarantino U, et al. Effects of Teriparatide Compared with Risedronate on Recovery After Pertrochanteric Hip Fracture: Results of a Randomized, Active-Controlled, Double-Blind Clinical Trial at 26 Weeks. J Bone Joint Surg Am. 2016;98(22):1868-1878. PMID: 27852903. DOI: 10.2106/JBJS.15.01217.
34. Malouf-Sierra J, Tarantino U, García-Hernández PA, et al. Effect of Teriparatide or Risedronate in Elderly Patients With a Recent Pertrochanteric Hip Fracture: Final Results of a 78-Week Randomized Clinical Trial. J Bone Miner Res. 2017;32(5):1040-1051. PMID: 28019683. DOI: 10.1002/jbmr.3067.
35. Hadji P, Zanchetta JR, Russo L, et al. The effect of teriparatide compared with risedronate on reduction of back pain in postmenopausal women with osteoporotic vertebral fractures. Osteoporos Int. 2012;23(8):2141-2150. PMID: 22159672. DOI: 10.1007/s00198-011-1856-y.
36. Tanavalee C, Ngarmukos S, Amarase C, et al. A randomized controlled trial of teriparatide for accelerating bone union and improving clinical outcomes in patients with pertrochanteric fracture fixation. Sci Rep. 2025;15(1):19465. PMID: 40461584. DOI: 10.1038/s41598-025-03720-2.
37. Lee SY, Seo MS, Yoo JI. Effectiveness of Weekly Teriparatide Injection in Postmenopausal Patients with Hip Fractures. Clin Orthop Surg. 2023;15(4):552-559. PMID: 37529188. DOI: 10.4055/cios22280.
38. Johansson T. PTH 1-34 (teriparatide) may not improve healing in proximal humerus fractures. A randomized, controlled study of 40 patients. Acta Orthop. 2016;87(1):79-82. PMID: 26179771. DOI: 10.3109/17453674.2015.1073050.
39. Nieves JW, Cosman F, McMahon D, et al. Teriparatide and pelvic fracture healing: a phase 2 randomized controlled trial. Osteoporos Int. 2022;33(1):239-250. PMID: 34383100. DOI: 10.1007/s00198-021-06065-4.
40. Ebrahimi S, Navabazam A, Salemi F, et al. The efficacy of teriparatide (Cinnopar®) on bone repair in mandibular fractures: A single blinded randomized clinical trial. J Craniomaxillofac Surg. 2022;50(12):923-928. PMID: 36646571. DOI: 10.1016/j.jcms.2022.12.002.
41. Almirol EA, Chi LY, Khurana B, et al. Short-term effects of teriparatide versus placebo on bone biomarkers, structure, and fracture healing in women with lower-extremity stress fractures: A pilot study. J Clin Transl Endocrinol. 2016;5:7-14. PMID: 29067229. DOI: 10.1016/j.jcte.2016.05.004.
42. Ebata S, Takahashi J, Hasegawa T, et al. Role of Weekly Teriparatide Administration in Osseous Union Enhancement within Six Months After Posterior or Transforaminal Lumbar Interbody Fusion for Osteoporosis-Associated Lumbar Degenerative Disorders: A Multicenter, Prospective Randomized Study. J Bone Joint Surg Am. 2017;99(5):365-372. PMID: 28244906. DOI: 10.2106/JBJS.16.00230.
43. Jespersen AB, Andresen ADK, Jacobsen MK, et al. Does Systemic Administration of Parathyroid Hormone After Noninstrumented Spinal Fusion Surgery Improve Fusion Rates and Fusion Mass in Elderly Patients Compared to Placebo in Patients With Degenerative Lumbar Spondylolisthesis? Spine (Phila Pa 1976). 2019;44(3):157-162. PMID: 30005049. DOI: 10.1097/BRS.0000000000002791.
44. Guity MR, Hoveidaei AH, Farsani AS, et al. Effectiveness of Teriparatide (rhPTH) in Enhancing Functional Recovery After Arthroscopic Rotator Cuff Repair: A Triple-Blind Randomized Clinical Trial. JB JS Open Access. 2025;10(3). PMID: 40978001. DOI: 10.2106/JBJS.OA.25.00035.
45. Oh JH, Kim DH, Jeong HJ, et al. Effect of Recombinant Human Parathyroid Hormone on Rotator Cuff Healing After Arthroscopic Repair. Arthroscopy. 2019;35(4):1064-1071. PMID: 30857903. DOI: 10.1016/j.arthro.2018.11.038.
46. Bashutski JD, Eber RM, Kinney JS, et al. Teriparatide and osseous regeneration in the oral cavity. N Engl J Med. 2010;363(25):2396-2405. PMID: 20950166. DOI: 10.1056/NEJMoa1005361. (NCT00277706.)
47. Sim IW, Borromeo GL, Tsao C, et al. Teriparatide Promotes Bone Healing in Medication-Related Osteonecrosis of the Jaw: A Placebo-Controlled, Randomized Trial. J Clin Oncol. 2020;38(26):2971-2980. PMID: 32614699. DOI: 10.1200/JCO.19.02192.
48. Ledin H, Good L, Johansson T, Aspenberg P. No effect of teriparatide on migration in total knee replacement. Acta Orthop. 2017;88(3):259-262. PMID: 28287044. DOI: 10.1080/17453674.2017.1300745.
49. Eastman K, Gerlach M, Piec I, et al. Effectiveness of parathyroid hormone (PTH) analogues on fracture healing: a meta-analysis. Osteoporos Int. 2021;32(8):1531-1546. PMID: 33559713. DOI: 10.1007/s00198-021-05847-0.
50. Agarwal N, Bell KR, Ross LE, et al. The effects of anti-osteoporotic medication on fracture healing and outcomes: a systematic review and meta-analysis. Lancet Healthy Longev. 2026;7(5):100827. PMID: 42229491. DOI: 10.1016/j.lanhl.2026.100827.
51. Kawaguchi H. Assessment of evidence for the off-label application of osteoanabolic drugs in fracture healing and spinal fusion. J Bone Miner Metab. 2025;43(2):57-60. PMID: 39964554. DOI: 10.1007/s00774-025-01589-9.
52. Porter R, Rees J. Pharmacologic Adjuncts for Bone Stress Injuries in Athletes: A Narrative Review of Current Evidence and Clinical Practice. Clin Ther. 2026;48(10):968-976. PMID: 42648994. DOI: 10.1016/j.clinthera.2026.08.006.
53. Carswell AT, Eastman KG, Casey A, et al. Teriparatide and stress fracture healing in young adults (RETURN - Research on Efficacy of Teriparatide Use in the Return of recruits to Normal duty): study protocol for a randomised controlled trial. Trials. 2021;22(1):580. PMID: 34461961. DOI: 10.1186/s13063-021-05556-3.
54. Tsai JN, Uihlein AV, Lee H, et al. Teriparatide and denosumab, alone or combined, in women with postmenopausal osteoporosis: the DATA study randomised trial. Lancet. 2013;382(9886):50-56. PMID: 23683600. DOI: 10.1016/S0140-6736(13)60856-9.
55. Tsai JN, Lee H, David NL, et al. Combination denosumab and high dose teriparatide for postmenopausal osteoporosis (DATA-HD): a randomised, controlled phase 4 trial. Lancet Diabetes Endocrinol. 2019;7(10):767-775. PMID: 31447409. DOI: 10.1016/S2213-8587(19)30255-4.
56. Ide M, Yamada K, Kaneko K, et al. Combined teriparatide and denosumab therapy accelerates spinal fusion following posterior lumbar interbody fusion. Orthop Traumatol Surg Res. 2018;104(7):1043-1048. PMID: 30179720. DOI: 10.1016/j.otsr.2018.07.015.
57. Radius Health, Inc. TYMLOS (abaloparatide) injection, for subcutaneous use. Prescribing information. DailyMed set ID 712143d9-e21e-4013-bb3b-3426a21060a8 (effective August 11, 2026). dailymed.nlm.nih.gov. Read October 4, 2026.
58. Adunsky A, Chandler J, Heyden N, et al. MK-0677 (ibutamoren mesylate) for the treatment of patients recovering from hip fracture: a multicenter, randomized, placebo-controlled phase IIb study. Arch Gerontol Geriatr. 2011;53(2):183-189. PMID: 21067829. DOI: 10.1016/j.archger.2010.10.004.
59. ClinicalTrials.gov. Teriparatide registrations: NCT00051558 (Eli Lilly, Phase 3, glucocorticoid-induced osteoporosis, 428 enrolled, completed 2008); NCT01709110 (Eli Lilly, Phase 4, VERO, completed 2016; posted results: new vertebral fractures in 28 of 516 participants on teriparatide and 64 of 533 on risedronate, among those with evaluable baseline and post-baseline spinal radiographs); NCT00190944 (Eli Lilly, Phase 2, distal radius fractures, 105 enrolled, completed 2007); NCT00887354 (Eli Lilly, Phase 4, MOVE, pertrochanteric hip fractures, 224 enrolled, primary outcome change in lumbar spine bone density at week 78, started April 2009, completed 2015); NCT00343252 (Eli Lilly, Phase 3, back pain after osteoporotic vertebral fractures, against risedronate, 712 randomized and 710 treated, completed 2010; read October 5, 2026); NCT01473589 and NCT01473602 (Eli Lilly, Phase 3, femoral neck fracture healing, 122 and 39 enrolled, started 2012, completed 2013); NCT03133195 (King Chulalongkorn Memorial Hospital, pertrochanteric fractures, 50, primary completion June 2022, completed July 2023); NCT01105832 (Linköping, proximal humerus fractures, 40, completed 2014); NCT02972424 (Hospital for Special Surgery, pelvic fractures, 35, completed 2021); NCT04589819 (University of South Carolina, Phase 4, tibial stress fractures in soldiers, enrolling by invitation, estimated primary completion December 30, 2026); NCT06303284 (University of Calgary, Phase 1/2 pilot after ankle-fracture surgery, not yet recruiting, estimated primary completion December 31, 2026); NCT03770338 (University of Hong Kong, before lumbar fusion, active, not recruiting, primary completion March 31, 2026, no results posted); NCT02090244 (University Hospital, Linköping, spinal fusion, 34, completed 2019, no results posted); NCT04196855 (University of East Anglia, RETURN, stress fractures in army recruits, status unknown, last updated 2020). clinicaltrials.gov, API v2. Read October 4, 2026.
60. U.S. Code of Federal Regulations. 21 CFR 216.23, Bulk drug substances that can be used to compound drug products in accordance with section 503A of the Federal Food, Drug, and Cosmetic Act, and 21 CFR 216.24. ecfr.gov. Read October 4, 2026.
61. 21 U.S.C. 353a, Pharmacy compounding (section 503A of the Federal Food, Drug, and Cosmetic Act), subsection (b)(1). law.cornell.edu/uscode/text/21/353a. Read October 4, 2026.
62. FDA. Bulk Drug Substances Nominated for Use in Compounding Under Section 503A of the Federal Food, Drug, and Cosmetic Act (categories 1–3). Updated May 14, 2026. fda.gov/media/94155/download.
63. FDA. Bulk Drug Substances Nominated for Use in Compounding Under Section 503B of the Federal Food, Drug, and Cosmetic Act (categories 1–3). Updated March 21, 2025. fda.gov/media/94164/download.
64. World Anti-Doping Agency. Prohibited List 2026 (in effect January 1, 2026). S0, Non-approved substances; S2, Peptide hormones, growth factors, related substances, and mimetics. wada-ama.org.
65. Searches of October 4, 2026: PubMed, “teriparatide” (4,025 records), “teriparatide[tiab]” (3,055), with randomized controlled trial[pt] (286), with fracture healing and randomized controlled trial[pt] (18), with fracture healing and meta-analysis or systematic review (13), with spinal, lumbar or interbody fusion and randomized (27), with rotator cuff (8), with osteonecrosis of the jaw and placebo-controlled (3), with stress fracture and randomized or placebo (8), with stress fracture and recruits, military or army (3; the RETURN protocol, no results), with denosumab, combination and randomized controlled trial[pt] (19; five trials gave the two drugs together: DATA, DATA-HD, a lumbar-fusion trial, a 4-year trial in Japanese women and a 2026 bone-biopsy trial), and teriparatide or PTH 1-34 with counterfeit, falsified, black market, research chemical, research use only, illicit or doping control (1 record, not a study of such a product); PubMed pairings of teriparatide with BPC-157, thymosin beta-4 or TB-500, GHK-Cu, ipamorelin, CJC-1295, sermorelin or tesamorelin (no records) and with ibutamoren or MK-677 (2 records, neither a study of the pair); ClinicalTrials.gov, teriparatide, Forteo, PTH 1-34 and parathyroid hormone 1-34 as interventions (182 registrations for teriparatide; 17 with an active status); FDA warning letters, full-text search for “teriparatide,” “Forteo” and “PTH 1-34” (no letters) and “parathyroid hormone” (one letter, about a PTH immunoassay kit); a laboratory supplier’s catalogue listing “Synthetic Human Parathyroid Hormone Protein” at an address naming PTH 1-34, “Research Use Only” (supplier not named). On October 5, 2026: PubMed, “teriparatide AND stress fracture” (71 records) and the same with randomized or placebo (8), “Malouf-Sierra J[au] AND teriparatide AND risedronate” (2); ClinicalTrials.gov, “teriparatide risedronate back pain vertebral fracture” (2 records).

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