Forteo ® (teriparatide [rDNA origin] 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.

Testing for a Pharmacodynamic Response to FORTEO® (teriparatide [rDNA origin] injection)

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

PINP as a marker for measuring pharmacodynamic response to teriparatide

A marker of bone formation, procollagen I N terminal propeptide (PINP), may be useful for monitoring pharmacodynamic response to Forteo® (teriparatide [rDNA origin] injection) as it 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 (Chen, 2005; Eastell, 2006; Glover, 2009; Lane, 2010; Blumsohn, 2011).

  • While 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 (Krege, 2014).

Additionally, increases in PINP have been correlated with later increases in bone mineral density in PMW with osteoporosis treated with teriparatide, but have not been directly validated to predict fracture risk reduction (Krege, 2014).

Enclosed Prescribing Information

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

The published references below are available upon request by contacting 1-800-LillyRx.


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

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.

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.

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.

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.

Lane NE, See K, Warner MR, 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.

Date of Last Review: February 17, 2017

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