Forteo vs. Prolia: 5 Differences Between These Osteoporosis Injections
Prolia (denosumab) and Forteo (teriparatide) are medications that are prescribed to treat osteoporosis. Is one better than the other? Here’s what you need to know.
teriparatide (Forteo)
Used for Osteoporosis
Used for Osteoporosis
Forteo (teriparatide) is a parathyroid hormone analog used to treat osteoporosis (weak bones). It's used in women who have gone through menopause, men, and people with weak bones from long-term steroid use. Forteo (teriparatide) is for people at high risk of broken bones or those who've already tried other osteoporosis medications. Forteo (teriparatide) is given as an injection once a day using a prefilled pen. Common side effects are body pain and joint pain. Forteo (teriparatide) is available as a brand-name and generic medication.
What is Forteo (teriparatide)?
What is Forteo (teriparatide) used for?
- Osteoporosis in women who've gone through menopause (postmenopausal)
- Osteoporosis in men
- Osteoporosis caused by long-term steroid use
How Forteo (teriparatide) works
Forteo (teriparatide) is a parathyroid hormone (PTH) analog. It works like PTH, a hormone your body makes to help keep your bones healthy.
By working like PTH, Forteo (teriparatide) helps your body build new bone. This raises your bone mineral density (BMD), which is a measure of how strong your bones are. Stronger bones are less likely to break.
When does Forteo (teriparatide) start working?Time passed since treatment started:
Drug facts
| Common Brands | Forteo |
|---|---|
| Drug Class | Parathyroid hormone analog |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
More on Forteo (teriparatide) essentials
Side effects of Forteo (teriparatide)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Body pain (21%)
- Joint pain (10%)
- Runny or stuffy nose (10%)
- Nausea (9%)
- Weakness (9%)
- Headache (8%)
- Dizziness (8%)
- High blood pressure (7%)
Less Common Side Effects
- Cough
- Sore throat
- Constipation
- Diarrhea
- Vomiting
- Indigestion
- Trouble breathing
- Pneumonia
- Depression
- Feeling like your surroundings are spinning (vertigo)
- Rash
Forteo (teriparatide) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- High calcium levels: tiredness, abnormal or irregular heartbeat, muscle weakness
- New or worsening open wound or ulcer on your skin
When do Forteo (teriparatide) possible side effects begin and end?
Time passed since treatment started:
M
H
D
W
M
Low blood pressure or dizziness after injection
More on Forteo (teriparatide) side effects
The following Forteo (teriparatide) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Confusion
headache
incoherent speech
increased urination
loss of appetite
metallic taste
muscle weakness
stomach pain
thirst
unusual tiredness
vomiting
Less common
Arm, back, or jaw pain
chest pain, discomfort, tightness, or heaviness
fainting
fast or irregular heartbeat
fever or chills
sweating
trouble breathing
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Acid or sour stomach
belching
blurred vision
body aches or pain
difficulty having a bowel movement (stool)
difficulty with moving
dizziness
hoarseness
indigestion
lack or loss of strength
muscle pain, stiffness, or spasm
nervousness
pain in the joints
pounding in the ears
runny or stuffy nose
tender, swollen glands in the neck
trouble with swallowing
voice changes
Less common
Back pain
discomfort
discouragement
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
feeling of constant movement of self or surroundings
feeling sad or empty
indigestion
irritability
lack of appetite
leg cramps
loss of interest or pleasure
neck pain
sensation of spinning
stomach cramps
swollen mouth and tongue
tiredness
tooth disorder
trouble concentrating
trouble sleeping
unpleasant taste
urge to have bowel movement
Incidence not known
Bleeding, blistering, burning, coldness, discoloration of skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
flushing
unusually warm skin
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Forteo (teriparatide)
Pros
- A first-choice option for postmenopausal women at very high risk of broken bones
- Can be used if other osteoporosis medications haven't worked well or caused bothersome side effects
- Helps lower the risk of broken bones in the spine and other areas in postmenopausal women
Cons
- Must be injected under the skin every day
- Can sometimes cause dizziness or low blood pressure after an injection
- Usually only used for up to 2 years during your lifetime, except in certain cases
Pharmacist tips for Forteo (teriparatide)
How to use Forteo (teriparatide):
- Read the User Guide before using Forteo (teriparatide). Your care team should show you how to use the pen before your first dose. Ask your prescriber or pharmacist if you have any questions.
- Don't share your Forteo (teriparatide) pen with anyone, even if you change the needle. Also, don't share needles. Sharing can spread infections from one person to another.
- The Forteo (teriparatide) pen doesn't come with needles. Ask your prescriber or pharmacist which needles to use. Be sure to use a new needle for each injection to help prevent infections.
- Inject Forteo (teriparatide) once a day under the skin of the outer part of your thigh or lower stomach. Change where you inject each day to help prevent skin irritation. Clean the area with an alcohol swab before each injection.
- Sit or lie down when you inject Forteo (teriparatide), especially during your first few doses. You might feel dizzy or lightheaded after the injection. If this happens, lie down until you feel better.
- To inject Forteo (teriparatide), place a new needle on the pen. Pull out the black injection button until you see the red stripe. Then, gently pinch your skin and push the needle straight in. Press and hold the black injection button all the way down while you slowly count to 5. Then, pull the needle straight out and lift your thumb off the injection button. Check that the button is pushed all the way in (this means you've done the injection correctly).
- Remove the needle after the injection and throw the needle away in a sharps container. This helps prevent you and others from getting hurt from needle sticks.
General tips:
- Keep Forteo (teriparatide) in the refrigerator when you're not using it. Use it right after taking it out of the fridge and put it back after each dose. Don't let the medication freeze or use it if it's been frozen.
- Throw away your Forteo (teriparatide) pen 28 days after you first use it, even if there's medication left.
- Ask your care team if you need calcium or vitamin D supplements along with Forteo (teriparatide). These can help keep your bones strong. Your care team can tell you how much to take.
- Get your bone density scans done as your care team recommends. A bone density scan (DEXA scan) helps show how well Forteo (teriparatide) is working. How often you need these scans done depends on several factors, but it's usually every few years.
- If you're pregnant or plan to become pregnant: Tell your prescriber right away. There isn't enough information to know if Forteo (teriparatide) is safe during pregnancy. Your prescriber can help decide if you need to stop Forteo (teriparatide) and find another treatment.
- If you're breastfeeding or plan to breastfeed: Avoid taking Forteo (teriparatide) while breastfeeding. It's not known if the medication passes into breast milk and how it affects a breastfed baby. Talk to your prescriber about other options.
Risks and warnings for Forteo (teriparatide)
Forteo (teriparatide) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Allergic reactions
Forteo (teriparatide) has caused serious allergic reactions. This can include anaphylaxis; hives; swelling of your face, lips, tongue, or throat; and trouble breathing. Stop using Forteo (teriparatide) and get medical help right away if you notice these signs. If you have a severe allergic reaction to Forteo (teriparatide), you shouldn't use it again.
Possible risk of bone cancer (osteosarcoma)
- Risk factors: Rickets | Paget's disease | Bones that are still growing | History of bone cancer | Cancer that has spread to the bones | Past radiation treatment to the bones | Inherited conditions that rise the risk of bone cancer
In animal studies, some rats treated with Forteo (teriparatide) developed a rare type of bone cancer called osteosarcoma. This cancer has been reported in some people taking Forteo (teriparatide). But studies haven't found that the medication raises the risk of this cancer in people.
To be safe, people at higher risk of bone cancer should avoid Forteo (teriparatide). This includes people with certain bone conditions (like Paget's disease) or a history of bone cancer. It also includes people who've had radiation treatment to their bones.
There isn't enough information about the risk of bone cancer after using Forteo (teriparatide) for more than 2 years. Because of this, it's usually used for no more than 2 years in your lifetime. Your prescriber might recommend longer treatment if you're still at high risk of broken bones or become high risk again. Your prescriber will help decide how long your treatment will be based on your risk of broken bones.
High calcium levels
- Risk factors: Conditions that can raise calcium levels | High PTH levels
Forteo (teriparatide) can cause high calcium levels in your blood. Avoid Forteo (teriparatide) if you already have high calcium or a condition that causes this. Forteo (teriparatide) can make it worse. Tell your care team if you have signs of high calcium while taking Forteo (teriparatide). This can include feeling tired, weak muscles, constipation, or not feeling hungry.
In rare cases, people taking Forteo (teriparatide) have had calcium build up in their skin and blood vessels. Your risk might be higher if you have an autoimmune condition or kidney failure. Taking Forteo (teriparatide) with warfarin or steroids like prednisone can also raise your risk. Stop taking Forteo (teriparatide) and tell your care team right away if you notice new or worsening sores on your skin, especially on your thighs or buttocks.
Risk of worsening kidney stones
- Risk factors: History of kidney stones | History of high calcium levels in your urine
Forteo (teriparatide) might make kidney stones worse if you already have them or have had them recently. Tell your prescriber if you have kidney stones or high calcium levels in your urine before starting Forteo (teriparatide). They might check your urine calcium levels to make sure this medication is safe for you.
Tell your care team right away if you have signs of a kidney stone. Watch for severe pain in your back or side, nausea, vomiting, or dark, cloudy, or bloody urine.
Low blood pressure when standing up
Forteo (teriparatide) can cause a drop in blood pressure when you stand up. This can make you feel dizzy or lightheaded. It can usually happen within 4 hours after your first few doses.
Sit or lie down when you inject Forteo (teriparatide) in case you feel dizzy or your heart races. If this happens, lie down until you feel better. Symptoms usually go away within a few minutes to a few hours. Tell your prescriber if your symptoms don't go away or get worse before taking your next dose.
Higher risk of serious side effects from digoxin (Lanoxin)
- Risk factors: Taking digoxin (Lanoxin) at the same time as Forteo (teriparatide)
Forteo (teriparatide) can raise calcium levels in your blood. This can raise your risk of serious side effects from the heart medication digoxin (Lanoxin). Signs include nausea, vomiting, changes in vision, or an uneven heartbeat.
Tell your prescriber if you take digoxin (Lanoxin) before starting Forteo (teriparatide). Also, let your cardiologist know if you start Forteo (teriparatide). Tell your care team right away if you notice any symptoms of serious digoxin side effects while taking both medications.
Forteo (teriparatide) dosage
The average cost for 1 pen of 20mcg/dose of Forteo (teriparatide) is $1,035.57 with a free GoodRx coupon. This is 66.85% off the average retail price of $3,123.96. 
Pen
Pen| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 20mcg/dose | 1 pen | $1,035.57 | $1,035.57 |
Interactions between Forteo (teriparatide) and other drugs
Forteo (teriparatide) may interact with certain medications or supplements. Always let your doctor and pharmacist know about any other medications or supplements (including prescribed and over-the-counter medications, vitamins, and dietary or herbal supplements) that you are currently taking. The list below does not include all possible drug interactions with Forteo (teriparatide). Please note that only the generic name of each medication is listed below.
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
How much does Forteo (teriparatide) cost?
To access savings, use a GoodRx coupon and pay just a fraction of the retail price.
What are alternatives to Forteo (teriparatide)?
There are a number of medications that your doctor can prescribe in place of Forteo (teriparatide). Compare a few possible alternatives below.
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Forteo (teriparatide) images
