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): Use After Prior Radiation Treatment

Forteo (teriparatide [rDNA origin] injection) should not be prescribed for patients who have had prior radiation treatment or needs radiation.


Teriparatide should not be prescribed for patients who are at an increased baseline risk for osteosarcoma, including those who have had prior external beam or implant radiation therapy.1

Radiation-induced osteosarcoma is a rare, but well-recognized, complication in human radiotherapy patients. Patients who have had prior radiation therapy have an increased risk of developing a radiogenic second malignant neoplasm, including osteosarcoma, some years or decades after initial treatment.2,3

Teriparatide Use With Prior Radiation Therapy

Examples of Prior Radiation Therapy Where Teriparatide Should Not be Used

Use of teriparatide should be avoided in patients who previously received

  • external beam radiation (stereotactic radiation), and

  • internal radiation (brachytherapy, interstitial radiation, intracavitary radiation).1,4

Radiation affecting any area of the skeleton should be avoided.1

Examples of Prior Radiation Therapy Where Teriparatide May be Considered

Use of teriparatide may be considered in patients who previously received

  • radioactive iodine therapy

  • low doses of non-penetrative radiation

  • diagnostic radiation (computed tomography scans, radiographs, radionuclide scans), and

  • nonradioactive forms of radiation (ultraviolet radiation, phototherapy).1,5

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. Forteo [package insert]. Indianapolis IN: Eli Lilly and Company; 2019.

2. Kalra S, Grimer RJ, Spooner D, et al. Radiation-induced sarcomas of bone: factors that affect outcome. J Bone Joint Surg Br. 2007;89-B(6):808-813.

3. Newhauser WD, Durante M. Assessing the risk of second malignancies after modern radiotherapy. Nat Rev Cancer. 2011;11(6):438-448.

4. American Cancer Society. Radiation therapy. Accessed February 4, 2020.

5. Data on file, Eli Lilly and Company and/or one of its subsidiaries.

Date of Last Review: February 23, 2020

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