Teriparatide, sold under brand names like Forteo and Bonsity, is an anabolic agent used to treat osteoporosis by stimulating new bone formation [1.4.5, 1.6.3]. It is administered once daily via a subcutaneous injection, meaning just under the skin [1.3.3]. Your healthcare provider will offer training, but this guide details the process for using the common multi-dose pen delivery system [1.3.3].
Preparing for Your Injection
Proper preparation ensures safety and efficacy. Always start by washing your hands thoroughly [1.2.3].
- Gather Supplies: You will need your teriparatide pen (which should be refrigerated), a new pen needle for each injection, and an alcohol swab [1.2.3, 1.5.3].
- Check the Pen: Remove the pen from the refrigerator. Check the label to ensure it's your medication and that it has not expired [1.5.3]. The medicine inside should be clear, colorless, and free of particles [1.3.1]. Do not use if it appears cloudy, colored, or frozen [1.5.4].
- Attach the Needle: Wipe the rubber seal on the pen with an alcohol swab [1.2.3]. Take a new needle, pull off the paper tab, and screw it firmly onto the pen [1.2.3]. Do not store the pen with the needle attached [1.5.3].
- Prime the Pen (for a new pen): The first time you use a new pen, you must prime it to ensure it's working correctly. Your pen's user manual will have specific instructions, which typically involve dialing a small test dose and discharging it into the air or an empty container until a drop of liquid appears [1.2.1, 1.2.5].
Administering the Injection
Teriparatide is typically injected into the thigh or abdomen [1.3.1]. It is crucial to rotate injection sites daily to prevent skin reactions like redness or lumps [1.3.5, 1.2.1]. For your first few doses, administer the injection where you can easily sit or lie down, as it can cause temporary dizziness [1.3.5].
Step-by-Step Injection Process:
- Select and Clean the Site: Choose a spot on your thigh or lower stomach area, avoiding the area directly around your navel. Clean the skin with an alcohol swab and let it air dry [1.2.1].
- Set the Dose: Most pens are pre-set to deliver the standard 20 mcg dose. This usually involves pulling an injection button until it clicks and stops [1.2.2, 1.2.3]. A red stripe or other indicator may become visible to show the dose is set [1.2.3].
- Inject the Medication: Gently pinch a fold of the cleaned skin. Insert the needle straight into the skin at a 90-degree angle [1.2.1].
- Deliver the Dose: Press the injection button all the way down until it stops. Hold the button in and slowly count to 5 or 10 (as per the manufacturer's instructions) before withdrawing the needle from your skin [1.2.2, 1.2.1]. This ensures the full dose is delivered.
- Confirm and Dispose: After removing the needle, check that the injection button is fully depressed and no yellow shaft (on a Forteo pen) or other indicator is showing [1.2.3]. Carefully place the large outer needle cap back on the needle, unscrew it from the pen, and dispose of it immediately in a designated sharps container [1.2.3]. Never reuse needles [1.5.3].
- Store the Pen: Place the white cap back on the pen and return it to the refrigerator immediately [1.5.1].
Teriparatide vs. Bisphosphonates
Patients with osteoporosis are often presented with different treatment options. Teriparatide works differently than more common first-line treatments like bisphosphonates (e.g., alendronate/Fosamax) [1.6.5].
| Feature | Teriparatide (e.g., Forteo) | Bisphosphonates (e.g., Fosamax) |
|---|---|---|
| Mechanism | Anabolic: Stimulates new bone formation [1.4.5] | Antiresorptive: Slows down bone loss/breakdown [1.6.3] |
| Administration | Daily subcutaneous injection [1.6.3] | Oral tablet (daily or weekly) [1.6.3] |
| Efficacy | Studies show it is superior to bisphosphonates in reducing vertebral and non-vertebral fracture risk [1.6.1, 1.6.2]. | Effective at reducing fracture risk, often used as first-line therapy [1.6.5]. |
| Common Side Effects | Dizziness, nausea, joint pain, injection site reactions [1.4.2, 1.4.4]. | Gastrointestinal issues (heartburn, indigestion) [1.6.3]. |
| Treatment Duration | Use beyond 2 years should only be considered if a patient remains at high risk for fracture [1.10.2]. | Can be used for longer periods. |
Important Considerations
- Storage: Always store your teriparatide pen in the refrigerator between 36°F to 46°F (2°C to 8°C). Do not freeze it [1.5.2]. When traveling, the pen can be kept at room temperature (up to 77°F) for a cumulative total of 36 hours [1.5.2].
- Supplements: Your doctor will likely advise you to take calcium and vitamin D supplements during treatment to support the new bone formation [1.3.3].
- Side Effects: Common side effects include pain, nausea, and dizziness [1.4.4]. Serious side effects can include high blood calcium levels (hypercalcemia) [1.4.2]. A boxed warning about a risk of osteosarcoma (bone cancer) observed in rat studies was removed from the Forteo label in 2020 after long-term human surveillance data did not show an increased risk [1.11.1, 1.11.3].
Conclusion
Taking teriparatide injections is a manageable daily routine for those with severe osteoporosis. By carefully following the steps for preparation, injection, and storage, patients can safely and effectively use this anabolic therapy to build bone and reduce the risk of fractures. Always follow the specific instructions provided by your healthcare professional and the user manual that accompanies your medication [1.3.3].
For more detailed information, you can review the Forteo User Manual from Eli Lilly [1.2.3].
