Bone & metabolism
Teriparatide
An anabolic (bone-building) osteoporosis drug — A daily injection that builds new bone in severe osteoporosis — used for a limited period.
Education and reference only. This is a plain-language class overview — it deliberately contains no doses. Always check the current Summary of Product Characteristics (SmPC), the BNF and your local formulary before prescribing or administering any medicine.
What it is
Teriparatide is a bone-building ("anabolic") treatment for severe osteoporosis, given as a daily injection for a limited period, usually for people at very high fracture risk or in whom other treatments have not worked.
How it works
It is a form of parathyroid hormone. Given as a once-daily pulse (rather than continuously), it stimulates the bone-building cells more than the bone-removing ones, so new bone is laid down and strength improves — the opposite approach to drugs that simply slow bone loss.
In practice
In practice teriparatide is different from most osteoporosis drugs: rather than slowing bone breakdown, it actively builds new bone, which makes it a powerful option for severe osteoporosis with multiple or recurrent fractures, or when other treatments have failed. It is a daily self-injection used for a limited, capped duration (because longer use is not licensed), after which the gain is "locked in" by following on with an antiresorptive drug such as a bisphosphonate or denosumab — without that follow-on, benefit is lost. Practical points include checking calcium beforehand (it should not be used in untreated high calcium), transient dizziness or palpitations after a dose, and a set of specific contraindications such as certain bone conditions, prior skeletal radiotherapy and unexplained raised alkaline phosphatase. It is a specialist-initiated treatment reserved for higher-risk patients.
Examples
Practical use
How to take it & use it well
- Teriparatide is given as a once-daily injection under the skin, using a pre-filled pen device, to build new bone in severe osteoporosis.
- You inject it yourself after training, usually into the thigh or abdomen, rotating the site each day.
- It is used for a time-limited course; once the course finishes, another bone-protecting medicine is usually started to keep the gains.
- Keep the pen in the fridge as directed, do not freeze it, and the first injection is often given where you can sit or lie down in case of dizziness.
- Take calcium and vitamin D as advised, as adequate levels support the treatment.
- Report persistent nausea, dizziness or palpitations, and follow up so the next stage of treatment can be planned.
Common uses
- Severe osteoporosis with high fracture risk
- Osteoporosis where other treatments have failed or are unsuitable
- Some steroid-induced osteoporosis
Monitoring
- Calcium status; tolerability after injections
- Adherence to the daily injection and the time-limited course
- Plan for follow-on bone-protecting treatment
Weighing it up
Advantages & disadvantages
Advantages
- Actively builds new bone, unlike treatments that mainly slow bone loss.
- Particularly useful for severe osteoporosis or where other treatments have not worked.
- Can significantly reduce the risk of spine and other fractures.
- Given as a convenient self-administered daily pen injection.
Disadvantages
- Requires a daily injection, which some people find inconvenient.
- Used only for a limited period, after which a follow-on medicine is needed.
- Can cause dizziness, leg cramps, nausea or a temporary rise in blood calcium.
- Must be kept refrigerated.
- Not suitable for everyone, including some people with other bone conditions or raised calcium.
Key safety principles
What to watch for
- Used for a limited, capped duration only; follow with an antiresorptive (e.g. bisphosphonate/denosumab) to maintain the gain.
- Check calcium first — avoid in untreated high calcium; transient dizziness/palpitations can follow a dose.
- Contraindicated in certain bone conditions, prior skeletal radiotherapy and unexplained raised alkaline phosphatase.
Key interactions
What to avoid or check alongside
- Can raise blood calcium, which may increase the risk of digoxin toxicity and heart rhythm problems, so this is monitored.
- Vitamin D and calcium supplements are usually needed, but very high doses combined could push calcium too high.
- Tell your team about medicines and conditions that affect calcium levels so treatment can be adjusted.
- Following teriparatide with an antiresorptive medicine is planned deliberately to preserve the bone gained rather than being an unwanted interaction.
Patient & carer advice
- You or a nurse will be shown how to give the daily injection
- Sit or lie down if you feel dizzy after a dose
- This is a time-limited course — afterwards another bone medicine keeps the benefit
Use with
Related clinical calculators
Dose and risk decisions for this class often depend on renal function, weight or bleeding/stroke risk. These tools help:
Answers
Teriparatide: frequently asked questions
Why is teriparatide only used for a limited time?
Teriparatide is given for a defined, time-limited course because long-term use is not recommended. A follow-on bone-protecting medicine is then usually started to keep the bone you have built.
What happens after I finish teriparatide?
The bone gains can be lost if nothing follows, so your team usually starts an antiresorptive medicine such as a bisphosphonate afterwards to maintain the benefit.
How do I take teriparatide?
It is a once-daily injection under the skin using a pre-filled pen, which you give yourself after training, usually into the thigh or tummy. The pen is kept in the fridge and not frozen.
Do I need calcium and vitamin D with it?
Yes, usually. Adequate calcium and vitamin D support the treatment, but your team will advise the right amount, as teriparatide can raise blood calcium.
Why might I feel dizzy after an injection?
Some people feel dizzy or light-headed shortly after a dose, especially at first. It is best to sit or lie down for the early injections, and tell your team if it is troublesome.
Authoritative sources
Always verify against the source
This overview is for orientation. For doses, interactions, contra-indications and the full monograph, use:
Related guides
Need a custom medicines or prescribing resource?
We build evidence-led clinical references, calculators and decision aids for teams.