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.

Use of FORTEO® (teriparatide [rDNA origin] injection) After Prior Radiation Treatment or During Treatment

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

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 (Kalra, 2007; Newhauser, 2011).

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 (Forteo Package Insert, 2012).

Examples of Prior Radiation Therapy Where Teriparatide Should Not Be Used

  • Therapeutic external beam radiation because most, if not all, likely impinges on some area of the skeleton (Data on file)

    • For example, patients who received radiation therapy for a soft tissue malignancy, such as breast cancer, likely have experienced radiation affecting the skeleton around the breast

  • Any type of radiation implanted into the body including

    • brachytherapy

    • interstitial radiation, or

    • intracavitary radiation (Data on file)

  • Stereotactic radiation to the brain or other areas of the body (American Cancer Society, WWW)

Examples of Prior Radiation Therapy Where Teriparatide May Be Considered

  • Radioactive iodine therapy (Data on file)

  • Low doses of non-penetrative radiation, such as Grenz radiation, for treatment of skin conditions (Data on file)

  • Diagnostic radiation such as computed tomography scans, radiographs, and radionuclide scans (Data on file)

  • Non-radioactive forms of radiation such as ultraviolet radiation and phototherapy (Data on file)

Radiation During or After Teriparatide Therapy

There are no studies to describe the effect of teriparatide exposure on subsequent risk of osteosarcoma in patients that have radiation therapy after teriparatide exposure.

If a patient is receiving teriparatide and develops a need for radiation therapy, Eli Lilly and Company advises that the teriparatide treatment be discontinued immediately or prior to radiation therapy.

Enclosed Prescribing Information

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

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


American Cancer Society. The science behind radiation therapy. Revised 2014. Available at:

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

Forteo [package insert]. Indianapolis, IN: Eli Lilly and Company; 2012.

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.

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

Date of Last Review: March 23, 2018

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