Teriparatide

(Forteo®)

Forteo®

Drug updated on 11/4/2024

Dosage FormInjection (subcutaneous; 600 mcg/2.4 mL [250 mcg/mL])
Drug ClassParathyroid hormone analogs
Ongoing and
Completed Studies
ClinicalTrials.gov

Indication

  • Indicated for the treatment of postmenopausal women with osteoporosis at high risk for fracture or patients who have failed or are intolerant to other available osteoporosis therapy
  • Indicated for the increase of bone mass in men with primary or hypogonadal osteoporosis at high risk for fracture or patients who have failed or are intolerant to other available osteoporosis therapy
  • Indicated for the treatment of men and women with osteoporosis associated with sustained systemic glucocorticoid therapy at high risk for fracture or patients who have failed or are intolerant to other available osteoporosis therapy.

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Summary
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  • This summary is based on the review of 23 systematic review(s)/meta-analysis(es). [1-23]
  • Teriparatide significantly increased bone mineral density (BMD) at the femoral neck, total hip, and lumbar spine compared to bisphosphonates in osteoporosis patients without prior bisphosphonate treatment, with similar BMD improvements noted in pregnancy and lactation-associated osteoporosis (PLO) patients over calcium/vitamin D and bisphosphonate treatments.
  • Teriparatide reduced fracture risk more effectively than bisphosphonates (RR (relative risk) = 0.61, 95% CI (confidence interval) [0.51, 0.74], P < 0.001) and showed significant reductions in vertebral fractures in glucocorticoid-induced osteoporosis (GIOP) (RR = 0.11, 95% CI [0.03-0.47]) as well as in new osteoporotic vertebral fractures compared to bisphosphonates like alendronate and risedronate.
  • Combined with percutaneous vertebroplasty (PVP) surgery, teriparatide resulted in significantly lower VAS pain scores compared to PVP alone, indicating enhanced pain relief in fracture management (MD = -4.99, 95% CI = [-7.45, -2.52]).
  • In cases of atypical femoral fractures and nonunion, teriparatide improved time to bone union and facilitated early bone healing compared to controls, supporting its role in fracture healing.
  • Teriparatide showed no significant increase in general adverse events compared to bisphosphonates (RR = 0.92, 95% CI [0.79, 1.08], P = 0.32) and similarly did not lead to increased adverse events when compared to denosumab.
  • Clinical trials and post-marketing surveillance indicate no elevated risk of osteosarcoma with teriparatide use, addressing a specific safety concern associated with this therapy.
  • Hypercalcemia was reported at a lower incidence in patients treated with abaloparatide compared to those receiving teriparatide, while romosozumab was associated with fewer injection-site reactions than teriparatide.

Product Monograph / Prescribing Information

Document TitleYearSource
Forteo (teriparatide) Prescribing Information.2024Eli Lilly and Company, Indianapolis, IN

Systematic Reviews / Meta-Analyses

Document TitleYearSource
Efficacy and safety of teriparatide vs. bisphosphonates and denosumab vs. bisphosphonates in osteoporosis not previously treated with bisphosphonates: a systematic review and meta-analysis of randomized controlled trials2024Archives of Osteoporosis
Cardiovascular Safety of Romosozumab Compared to Commonly Used Anti-osteoporosis Medications in Postmenopausal Osteoporosis: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials2024Drug Safety
Effects of different drugs in combination with PKP/PVP on postoperative pain in patients with osteoporotic compression fractures: a network meta-analysis2024Frontiers in Surgery
Comparison of the Clinical Efficacy of Anabolic Agents and Bisphosphonates in the Patients With Osteoporotic Vertebral Fracture: Systematic Review and Meta-analysis of Randomized Controlled Trials2024Neurospine
The effect of teriparatide on patients with atypical femur fractures: a systematic review and meta-analysis2024Archives of Orthopaedic and Trauma Surgery
Comparative Effectiveness of Therapeutic Interventions in Pregnancy and Lactation-Associated Osteoporosis: A Systematic Review and Meta-analysis2024The Journal of Clinical Endocrinology and Metabolism
The Risk of Developing Osteosarcoma After Teriparatide Use: A Systematic Review2023Orthopedic Research and Reviews
Efficacy of osteoporosis pharmacological treatments in men: a systematic review and meta-analysis2023Aging Clinical and Experimental Research
Efficacy and Safety of Teriparatide in Improving Fracture Healing and Callus Formation: A Systematic Review2023Cureus
Is abaloparatide more efficacious on increasing bone mineral density than teriparatide for women with postmenopausal osteoporosis? An updated meta-analysis2023Journal of Orthopaedic Surgery and Research
Interventions for managing medication-related osteonecrosis of the jaw2022The Cochrane Database of Systematic Reviews
Importance of Time Point-Specific Indirect Treatment Comparisons of Osteoporosis Treatments: A Systematic Literature Review and Network Meta-Analyses2022Clinical Therapeutics
Romosozumab versus Teriparatide for the Treatment of Postmenopausal Osteoporosis: A Systematic Review and Meta-analysis through a Grade Analysis of Evidence2021Orthopaedic Surgery
The effect of osteoporosis and its treatment on fracture healing a systematic review of animal and clinical studies2021Bone Reports
Surgical Treatment for Bisphosphonate-related Atypical Femoral Fracture: A Systematic Review2021The Archives of Bone and Joint Surgery
Pharmacological interventions versus placebo, no treatment or usual care for osteoporosis in people with chronic kidney disease stages 3-5D2021The Cochrane Database of Systematic Reviews
The efficacy of teriparatide on lumbar spine bone mineral density, vertebral fracture incidence and pain in post-menopausal osteoporotic patients: A systematic review and meta-analysis2020Bone Reports
Does Teriparatide Improve Fracture Union?: A Systematic Review2020Journal of Bone Metabolism
The Efficacy of Teriparatide in Improving Fracture Healing in Hip Fractures: A Systematic Review and Meta-Analysis2020Biomed Research International
Denosumab, raloxifene, romosozumab and teriparatide to prevent osteoporotic fragility fractures: a systematic review and economic evaluation2020Health Technology Assessment (winchester, England)
Clinical efficacy and safety of drug interventions for primary and secondary prevention of osteoporotic fractures in postmenopausal women: Network meta-analysis followed by factor and cluster analysis2020Plos One
The Treatment of Acute Diaphyseal Long-bones Fractures with Orthobiologics and Pharmacological Interventions for Bone Healing Enhancement: A Systematic Review of Clinical Evidence2020Bioengineering (basel, Switzerland)
Efficacy and Safety of First- and Second-Line Drugs to Prevent Glucocorticoid-Induced Fractures2020The Journal of Clinical Endocrinology and Metabolism

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