Understanding Forteo (Teriparatide) and Its Use
Forteo is the brand name for teriparatide, a prescription medication used to treat osteoporosis [1.2.4]. It is a synthetic version of a portion of the human parathyroid hormone (PTH) [1.3.4, 1.5.4]. Unlike other osteoporosis drugs that prevent bone breakdown, Forteo is an anabolic agent, meaning it works by stimulating new bone formation, thereby increasing bone mineral density and strength [1.5.2, 1.6.1].
Health Canada has approved Forteo for specific patient groups who are at high risk of fractures [1.3.2]:
- Postmenopausal women with severe osteoporosis who have not responded to or cannot tolerate other treatments.
- Men with primary or hypogonadal severe osteoporosis who have failed or are intolerant to previous therapy.
- Men and women with osteoporosis caused by long-term use of glucocorticoid medications (like prednisone) [1.3.2, 1.3.4].
Forteo is administered as a once-daily self-injection under the skin of the thigh or abdomen [1.5.2]. Due to a potential risk of bone cancer (osteosarcoma) seen in animal studies, its use in humans is typically limited to a lifetime maximum of 24 months [1.6.1, 1.9.4].
Can You Buy Forteo in Canada?
Yes, Forteo is a marketed drug in Canada, approved by Health Canada since July 2004 [1.2.2]. However, it is classified as a Schedule F prescription drug, meaning you cannot purchase it over-the-counter [1.2.2]. A prescription from a licensed Canadian physician is mandatory.
The process generally involves:
- Consultation with a Physician: A doctor, often a specialist like a rheumatologist or endocrinologist, must evaluate your condition. This includes assessing your fracture risk, bone mineral density (BMD), and medical history to determine if Forteo is the appropriate treatment [1.7.2].
- Receiving a Prescription: If you meet the criteria, the physician will write a prescription.
- Dispensing at a Pharmacy: You can then have the prescription filled at a Canadian pharmacy. Forteo is a specialty drug that may require specific handling, such as refrigeration [1.9.5].
Cost and Coverage of Teriparatide in Canada
The cost of Forteo in Canada can be substantial. Prices at a single Canadian pharmacy can be around $1,219 CAD for a 2.4mL pen [1.4.1]. However, costs can vary between pharmacies and provinces.
Provincial drug benefit programs may offer coverage, but often with restrictions. For example, in many provinces, patients must have first tried and failed, or have a contraindication to, less expensive treatments like oral bisphosphonates before qualifying for coverage for teriparatide [1.7.2]. In May 2024, Ontario moved Forteo and its generic equivalent from the Exceptional Access Program (EAP) to a Limited Use (LU) benefit, streamlining access for those who meet the specific criteria [1.2.3, 1.3.1].
Forteo Alternatives: Biosimilars and Generics in Canada
In Canada, patients have access to alternatives to the brand-name Forteo, which can offer significant cost savings. By late 2023, biosimilars accounted for 73% of the teriparatide market units in Canada [1.5.5].
Health Canada has approved several teriparatide products [1.5.1]:
- Forteo®: The original brand-name drug.
- Teva-teriparatide: A generic version considered interchangeable with Forteo [1.3.1, 1.5.2].
- Osnuvo®: A biosimilar to Forteo. While it has the same active ingredient and is considered equally effective, it is not designated as directly interchangeable at the pharmacy level without consulting the prescriber [1.5.1, 1.5.2].
- Apo-teriparatide: Another approved teriparatide biosimilar [1.5.3].
These alternatives provide the same therapeutic action as Forteo—stimulating new bone growth [1.5.2]. The availability of these products has increased competition and can lower the financial burden on patients and public drug plans.
Forteo vs. Other Osteoporosis Medications
Forteo's mechanism of action sets it apart from the most common class of osteoporosis drugs, bisphosphonates.
| Feature | Forteo (Teriparatide) | Bisphosphonates (e.g., Alendronate) |
|---|---|---|
| Mechanism | Anabolic: Stimulates new bone formation [1.5.2] | Anti-resorptive: Slows down bone loss [1.6.1] |
| Administration | Daily subcutaneous injection [1.6.1] | Oral pill (daily or weekly) [1.6.1] |
| Indication | Severe osteoporosis, high fracture risk, or failure of other therapies [1.2.4, 1.3.2] | Prevention and treatment of osteoporosis [1.6.1] |
| Treatment Duration | Typically limited to 24 months in a lifetime [1.6.3] | Can be used for longer periods [1.6.1] |
| Effectiveness | Studies show it is better than bisphosphonates at preventing spinal fractures and increasing BMD [1.6.2, 1.6.4, 1.6.5] | Effective at strengthening bones and reducing fracture risk [1.6.1] |
| Common Side Effects | Dizziness, nausea, joint pain, leg cramps [1.5.2, 1.9.3] | Stomach pain, heartburn, muscle pain [1.6.1] |
Purchasing from Canada for Personal Importation (e.g., to the U.S.)
While it is medically possible to get a prescription and buy Forteo in Canada, U.S. residents considering this option face significant legal and logistical hurdles. In most cases, it is illegal for individuals to import prescription drugs into the United States for personal use [1.10.1, 1.10.3].
The FDA's Personal Importation Policy (PIP) allows for certain exceptions, but they are narrow. Generally, a drug may be allowed if:
- It treats a serious condition for which no effective treatment is available in the U.S. [1.10.4].
- It is for personal use for a 90-day supply or less [1.10.4].
- It does not present an unreasonable risk [1.10.3].
- You have a valid prescription or doctor's note in English [1.10.1].
Since FDA-approved teriparatide generics are available in the U.S., it is unlikely that importing Forteo or its Canadian equivalents would meet the 'no effective treatment available' criteria [1.2.5]. Shipments can be confiscated by Customs and Border Protection [1.10.3].
Conclusion
You can buy Forteo (teriparatide) in Canada, but it is strictly a prescription medication for severe osteoporosis. Its high cost is a significant factor, but the availability of Health Canada-approved generic and biosimilar versions like Teva-teriparatide and Osnuvo offers more affordable, equally effective alternatives [1.3.1, 1.5.1]. Patients must undergo a thorough medical evaluation to obtain a prescription, and coverage through provincial drug plans often has specific criteria. While purchasing from Canada may seem attractive to foreign nationals, particularly from the U.S., personal importation is highly regulated and generally illegal, making it an impractical and risky option.
For more information on osteoporosis treatment, you can visit Osteoporosis Canada.
