Teriparatide
Proven to cut fractures in osteoporosis at high risk.
The first 34 amino acids of . Given as a daily pulse, it builds new bone, which most osteoporosis drugs cannot do. A made by Eli Lilly and copy makers, also called Forteo, Forsteo and PTH 1-34.
What the evidence shows
Side effects and risks
Who should avoid it: Children and teenagers whose bones are still growing, and people with Paget's disease, past radiation to the skeleton, or bone tumors.
How it works
- Where it acts
- PTH1 receptors on bone-building cells.
- What it changes
- A short daily pulse builds new bone faster than the body removes it.
- What people notice
- Fewer spine fractures. Dizziness and leg cramps can occur. It is usually used for up to two years.
How it is taken
A 20 microgram injection under the skin once a day, usually for up to two years. Another bone drug normally follows to hold the gain.
Getting it in the United States
The legal route for Teriparatide
Get a prescription from a licensed clinician. Fill it at a licensed pharmacy or through the maker's own direct service.
Prescription pen from pharmacy
Sold on prescription as a prefilled multi-dose pen under two brand names. It needs refrigeration and use is limited to about two years. Fracture-healing use is off label, so cover is uncertain.
Source: MedlinePlus drug information
Routes people use for any peptide in the United States
Telehealth prescribing
Online clinics prescribe after a questionnaire, sometimes with no live doctor visit, and mail the drug. FDA moved in February 2026 to restrict mass-marketed compounded copies and claims that they are generic equivalents.
Risk: Thin medical screening. Compounded versions are not reviewed by FDA for quality.
Covers: Approved GLP-1 drugs, compounded semaglutide and tirzepatide
Source: GZERO Media, Apr 2026
Clinical trial enrolment
The only lawful way to get an unapproved peptide drug with medical monitoring. ClinicalTrials.gov lists eligibility, sites and phone numbers. Researchers note recruitment is hard when people can buy the drug on the gray market instead of risking placebo.
Risk: Possible placebo assignment, strict eligibility and travel to a study site.
Covers: Investigational peptide drugs still in development
Source: NIH, finding a clinical trial
Routes people use for any peptide in the United States
Compounding pharmacy with prescription
A clinician prescribes and a pharmacy compounds. Twelve peptides left the FDA do-not-compound category in April 2026 and a panel backed six in July, but they are not yet formally eligible. Pharmaceutical-grade ingredient is scarce.
Risk: Legal status is unsettled until FDA rulemaking ends. Pharmacies may use research-grade ingredient.
Covers: BPC-157, TB-500, KPV, MOTS-c, Semax, Epitalon and similar
Source: Frier Levitt, Apr 2026
Med spas and weight-loss clinics
Very common. Secret shoppers called 75 clinics and med spas in two states after shortages ended. 92 percent offered compounded semaglutide and 87 percent tirzepatide, often mixed with B vitamins to look custom.
Risk: Four of 23 suppliers lacked sterile compounding licenses and four had disciplinary records.
Covers: Compounded semaglutide and tirzepatide
Source: American Med Spa Association on JAMA Health Forum study, Jul 2026
Concierge and longevity doctors
Cash-pay physicians build peptide plans for wealthy clients. Reporting from San Francisco says some source from overseas channels, domestic research-use-only sellers or the few compounding pharmacies that will supply clinicians.
Risk: A doctor's involvement does not guarantee a pharmaceutical-grade product.
Covers: BPC-157, thymosin alpha-1, Selank, Semax, CJC-1295, ipamorelin, retatrutide
Source: San Francisco Standard, Sep 2025
Cross-border purchase or import
FDA says importing drugs for personal use is illegal in most cases but it may not object to small personal quantities in limited situations. Reporting also describes people travelling to Mexico for injections.
Risk: Packages can be seized. Product origin and cold-chain handling are hard to check.
Covers: Approved prescription peptides sold abroad
Source: FDA, personal importation
Routes people use for any peptide in the United States
Research-chemical websites
Sites sell vials marked for research or not for human consumption, with no prescription. FDA says some ship direct to consumers with dosing directions, and it has sent warning letters. Retatrutide exists only through this route or trials.
Risk: Unknown identity, strength and sterility. No pharmacist or prescriber involved.
Covers: Retatrutide, semaglutide, tirzepatide, BPC-157 and most unapproved peptides
Source: FDA, unapproved GLP-1 drugs page
Direct orders from Chinese factories
Buyers message factory sales agents and pay by crypto or payment app. A minimum order of about ten vials pushes people to buy in bulk and share. A blockchain analysis found US buyers were the largest source of funds.
Risk: Many of the same vendors list fentanyl precursors. Lab reports sent by sellers cannot be verified.
Covers: GLP-1 copies, melanotan II, BPC-157, TB-500, GHK-Cu, epitalon
Source: TRM Labs, Oct 2026
Chat groups and social sellers
Dealers are found through Telegram, WhatsApp, Discord and influencer discount codes. In a May 2026 survey of 1,000 US users, 14.5 percent bought this way and three quarters asked an AI chatbot for dosing.
Risk: 45 percent of social media buyers in that survey reported an emergency or urgent care visit for a reaction.
Covers: Retatrutide and other research-use-only peptides
Source: The Ethos, May 2026
This describes what people do. It is not advice. The decision is yours.
More contextCase reports, what public figures say, videos and articles, when options run out and the chemistry
Case reports
From journals, regulators and studies of users. One case proves little.
Benefit reportedcase report - 1 person - 2025
A 21-year-old Division I basketball player with a grade 4 tibial shaft stress fracture had boot, rest and a short off-label course. Pain cleared by week seven, MRI normalised and he played every game that season.
Mixed resultcase series - 22 people - 2025
Adults aged 18-55 with leg or pelvic stress fractures were followed for about six years. Early starters all had pain relief. Four of 12 late starters did not respond. No severe adverse events were reported.
Source: ISAKOS Congress abstract, 2025
Benefit reportedcase series - 145 people - 2011
A US orthopaedic series of painful delayed unions and non-unions, as relayed at a 2011 meeting, reported 93 percent fully healed within 12 weeks. It was retrospective with no control group.
Benefit reportednews-reported case - 1 person - 2011
A meeting speaker described footballer Francesco Totti as reportedly starting the drug soon after a 2006 leg fracture and playing in that summer's World Cup. The speaker presented this as anecdote, not evidence.
What experts and influencers say
Paraphrased from the linked sources.
Told a bone research meeting that off-label use for fracture repair was gaining traction, including in elite athletes, but said he did not promote it and that a proper randomised trial was still needed.
Robert MarcusSourceMixed view
Money: Consultant and speaker for Eli Lilly, former employee
Published a case of a college basketball player with a severe tibial stress fracture treated without surgery plus a short off-label course. They reported full return to play in about seven weeks.
Patrick Laird and co-authorsSourceRecommends
Reported a small retrospective series of off-label use for stress fractures. They cautiously suggested short early courses may help and called the findings preliminary.
Source: ISAKOS Congress abstract, 2025
Joseph Lane and Hospital for Special Surgery teamSourceMixed view
Their systematic review found no randomised trials for non-union, only case reports and small series. They concluded the drug may shorten healing time but top-level evidence is missing.
Byung-Ho Yoon and Ki-Chan KimSourceMixed view
Designed the RETURN trial, which randomises Army recruits with MRI-confirmed stress fractures to standard care with or without teriparatide, because the benefit in healthy young adults is unproven.
Source: Trials journal protocol, 2021-08
RETURN trial investigatorsSourceMixed view
Proposed that Wales adopt England's criteria for men with severe osteoporosis, to end unequal access by sex and by side of the border. Noted biosimilars have cut the cost since 2008 rejections.
Source: AWTTC evidence summary, 2025-05
All Wales Therapeutics and Toxicology CentreSourceRecommends
Watch and read
Explainers, reporting and podcasts worth your time. Summaries are ours. No sellers.
Teriparatide Injection: MedlinePlus Drug Information
National Library of Medicine, NIH
Plain-language patient guide to teriparatide for osteoporosis, covering what it is, precautions, calcium and vitamin D advice, side effects and storage.
Trusted NIH patient guide to the approved drug
When options run out
Uses people turn to when standard treatment has failed.
Fractures that fail to heal
- Who
- Patients with painful delayed union or non-union after surgery or casting, offered it by orthopaedic surgeons before further operations.
- Evidence
- Case reports and uncontrolled series report union. A 2020 systematic review found no randomised trial for non-union.
Stress fractures in athletes and recruits
- Who
- Young athletes and soldiers who want a faster return to sport or duty, though the label covers osteoporosis only.
- Evidence
- One case report and a 22-person retrospective series. A 136-person randomised trial in Army recruits was registered, with no results in the protocol paper.
- Route
- RETURN randomised trial in Army recruits
Source: Trials journal protocol, 2021-08
After jaw necrosis or atypical femur fracture
- Who
- Older people harmed by antiresorptive drugs who still have severe osteoporosis and cannot go back to those drugs.
- Evidence
- Studies of healing in atypical femur fractures are small and gave mixed results.
- Route
- Ontario public drug plan limited-use criteria
Legal last-resort routes
Expanded access (compassionate use)
For a serious or life-threatening condition with no comparable alternative and no trial you can join. Your physician asks the company for the drug, then files with FDA and an ethics board. The company can refuse. Costs are often not insured.
Right to Try
For a life-threatening condition after approved options are exhausted and no trial is open to you. The drug must have finished Phase 1 and be in active development. Your doctor asks the manufacturer directly. FDA does not review requests.
Source: FDA, Right to Try
Trial finders
Search ClinicalTrials.gov by condition or drug name, check eligibility and call the listed site. ResearchMatch is a free NIH-funded registry that lets researchers find you. Discuss risks with your own clinician before enrolling.
Source: NIH, finding a clinical trial
Personal import for serious conditions
FDA may not object when a US citizen imports up to about three months of a drug for a serious condition with no effective US treatment, with written personal-use confirmation and a US doctor's details. It is discretion, not a right.
Source: FDA, personal importation
Patient-specific compounding
When the approved product cannot meet a specific need of an identified patient, a prescriber can order a compounded version from a licensed pharmacy. Lower price alone does not qualify. Ingredients must be pharmaceutical grade.
Amino-acid sequence
Questions people ask
How well does teriparatide prevent fractures?
In 1,637 postmenopausal women over 19 months, new spine fractures fell from 14.3% to 5.0% and other fractures from 5.5% to 2.6%.
How long can you take teriparatide?
It is usually used for up to two years, and another bone drug normally follows to hold the gain.
Does teriparatide cause bone cancer?
Bone cancer (osteosarcoma) occurred in rats. Children and teenagers whose bones are still growing, and people with Paget's disease, past radiation to the skeleton or bone tumors, should avoid it.
What are the side effects of Forteo?
Dizziness or a racing heart shortly after a dose, leg cramps, nausea and raised blood calcium.
Are there cheaper versions of Forteo?
Yes. Lower-cost teriparatide injections are sold in the US, and biosimilars such as Movymia and Terrosa in the EU.
Your notebook
Taking it? A ten-second daily check-in keeps a record of how you feel, to talk through with your clinician.
Sources
Structure: PubChem