Forteo ® (teriparatide injection)

20-mcg daily dose in a 2.4-mL prefilled delivery device

This information is provided in response to your request. Resources may contain information about doses, uses, formulations and populations different from product labeling. See Prescribing Information above, if applicable.

FORTEO® (teriparatide [rDNA origin] injection): Pharmacodynamic Response

PINP has been shown to be an aid for monitoring pharmacodynamic response to Forteo.


PINP has been shown to be an aid for monitoring pharmacodynamic response to teriparatide.

PINP as a Marker for Measuring Pharmacodynamic Response to Teriparatide

For monitoring pharmacodynamic response to teriparatide, PINP may be a useful marker. 

Serum N-terminal propeptide of type I procollagen

  • increases rapidly after initiation

  • remains elevated during continued treatment

  • is not greatly impacted by food or circadian rhythm effects, and

  • has a high signal-to-noise ratio.1-5

Although previous treatment with antiresorptive drugs have been shown to delay the initial PINP response to teriparatide, an increase can be seen with continued teriparatide treatment.5,6

Additionally, increases in PINP have been correlated with later increases in BMD in PMW with osteoporosis treated with teriparatide, but have not been directly validated to predict fracture risk reduction.6

Enclosed Prescribing Information

FORTEO® (teriparatide [rDNA origin] injection), Lilly


The published references below are available by contacting 1-800-LillyRx (1-800-545-5979).

1. Chen P, Satterwhite JH, Licata AA, et al. Early changes in biochemical markers of bone formation predict BMD response to teriparatide in postmenopausal women with osteoporosis. J Bone Miner Res. 2005;20(6):962-970.

2. Eastell R, Krege JH, Chen P, et al. Development of an algorithm for using PINP to monitor treatment of patients with teriparatide. Curr Med Res Opin. 2006;22(1):61-66.

3. Glover SJ, Eastell R, McCloskey EV, et al. Rapid and robust response of biochemical markers of bone formation to teriparatide therapy. Bone. 2009;45(6):1053-1058.

4. Lane NE, See K, Warner M, Krege JH. Algorithm for using a bone formation marker PINP to monitor the response to teriparatide (TPTD) in patients with glucocorticoid-induced osteoporosis (GIO) [abstract]. Arthritis Rheum. 2010;62(suppl S10):957.

5. Blumsohn A, Marin F, Nickelsen T, et al. Early changes in biochemical markers of bone turnover and their relationship with bone mineral density changes after 24 months of treatment with teriparatide. Osteoporos Int. 2011;22(6):1935-1946.

6. Krege JH, Lane NE, Harris JM, Miller PD. PINP as a biological response marker during teriparatide treatment for osteoporosis. Osteoporos Int. 2014;25(9):2159-2171.


BMD = bone mineral density

PINP = serum N-terminal propeptide of type I procollagen

PMW = postmenopausal women

Date of Last Review: January 29, 2020

Contact Lilly

Call Us

If you need information about a Lilly product or want to report an Adverse Event or Product Complaint, you may call us.

Available Mon – Friday, 9am-7pm (EST), excluding holidays

Or you can

Chat with us

Chat with us

Submit a Request

Visit Us @LillyMedical