Forteo, Teriparatide (generic)
Evidence Grade A — Regulatory approved. 2914 published studies. 176 registered clinical trials.
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Teriparatide (sold as Forteo and generics) is a bone-building medication used for severe osteoporosis — it was the first treatment that actually stimulates the formation of new bone, rather than just slowing bone loss. Given as a daily injection, it reduced spinal fractures by 65% in its landmark trial. It is now available as a generic, making it more accessible than ever.
2,914 published studies: 2054 human, 172 animal, 81 in-vitro, 844 reviews
Teriparatide is marketed as Forteo (approved November 2002), with generic versions available since 2023. It is indicated for osteoporosis in postmenopausal women and men at high fracture risk. The landmark Fracture Prevention Trial demonstrated a 65% reduction in vertebral fractures and a 53% reduction in non-vertebral fractures compared to placebo.
Treatment is limited to two years due to a preclinical finding of bone tumours in rats given high doses over their lifetime — though this has never been observed in humans over two decades of clinical use. After stopping teriparatide, patients typically transition to an anti-resorptive medication (like a bisphosphonate) to maintain the bone gains. Teriparatide is now facing competition from abaloparatide, which works through a related but distinct mechanism, and romosozumab, a non-peptide monoclonal antibody with dual anabolic and anti-resorptive action.
This is where teriparatide gets counterintuitive: parathyroid hormone continuously elevated in the blood actually breaks bone down (as seen in hyperparathyroidism). But when given as a brief daily pulse — a single injection that spikes then clears — it has the opposite effect: it stimulates bone-building cells (osteoblasts) to form new bone. This intermittent exposure activates growth and survival signals in osteoblasts without triggering the bone-resorption pathway. The result is genuine new bone formation, not just preservation of existing bone.
The Fracture Prevention Trial demonstrated a 65% reduction in vertebral fractures and 53% reduction in non-vertebral fractures compared to placebo — establishing teriparatide as a cornerstone treatment for severe osteoporosis. Over 20 years of use have confirmed its safety and effectiveness. Generic availability since 2023 has significantly improved access. Treatment was historically limited to two years due to a preclinical finding of bone tumours in rats, though this has never been observed in humans despite two decades of monitoring. The standard approach is to follow teriparatide with an anti-resorptive medication (like a bisphosphonate) to maintain the bone gains — the sequential therapy paradigm is now well established. Teriparatide faces competition from abaloparatide (a related bone-builder) and romosozumab (a non-peptide monoclonal antibody with both bone-building and bone-preserving effects).
A Study Aimed at Assessing the Pharmacokinetic Properties of RGB-10 and Forsteo
Combined Use of Teriparatide and Raloxifene in Postmenopausal Women With Osteoporosis
A Study of B-3E07 and Forsteo® in Healthy Adult Female Participants
Bone Turnover Markers and Treatment Efficacy in Postmenopausal Osteoporosis
Chronotherapeutic Optimization of Teriparatide Administration in Postmenopausal Osteoporosis
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Exenatide was the first GLP-1 receptor agonist approved anywhere, reaching the market as Byetta in April 2005. The once-weekly formulation Bydureon followed in 2012. Clinical trials showed blood sugar reductions (HbA1c) of 1.6–1.9% and modest weight loss of 2–4 kg. The EXSCEL cardiovascular outcomes trial, involving over 14,700 patients, showed a trend toward cardiovascular benefit but narrowly missed statistical significance. While exenatide was groundbreaking as the first in its class, it has been largely overtaken by newer GLP-1 treatments that offer greater efficacy, less frequent dosing, and proven cardiovascular benefits. It remains available and in clinical use, particularly in combination products.
Lixisenatide was marketed as Adlyxin in the US (approved July 2016), though it has since been discontinued in the US market. The ELIXA cardiovascular trial, involving over 6,000 patients, was the first cardiovascular outcomes trial for any GLP-1 medication to report results. It showed a neutral cardiovascular profile — neither harmful nor beneficial — meeting safety requirements but not demonstrating the heart benefits later shown by semaglutide and liraglutide. Lixisenatide found its primary clinical role in combination with basal insulin, marketed as Soliqua (lixisenatide plus insulin glargine). This combination addresses both fasting blood sugar (via insulin) and post-meal spikes (via lixisenatide) in a single daily injection. As a standalone treatment, it has been largely superseded by more potent GLP-1 medications.
Pramlintide is marketed as Symlin (approved March 2005) and remains the only approved amylin-based treatment. It is used alongside mealtime insulin in both type 1 and type 2 diabetes. Clinical trials showed modest blood sugar improvements (HbA1c reductions of 0.2–0.6%) and approximately 2.3 kg of weight loss — less dramatic than GLP-1 treatments but meaningful as an add-on therapy. Symlin carries a boxed warning for severe hypoglycaemia, particularly when combined with insulin, and requires careful dose adjustment. Practical uptake has been limited by the need for separate injections at each meal alongside existing insulin injections. Despite its modest clinical impact, pramlintide remains the only medication that addresses the amylin deficiency in diabetes, filling a distinct biological role that GLP-1 treatments do not cover.
