In a recent JBMB publication, “A Ten-Year Review of the Safety of Bone Formation Promoting Drugs,” it was mentioned that among the therapeutic agents that can control osteoporosis and effectively reduce the risk of fracture due to osteoporosis in the past two decades, teriparatide [recombinant human PTH(1-34)] is the only bone anabolic agent currently approved for application, and was approved by the FDA in November 2002 for the treatment of postmenopausal osteoporosis It was approved by the FDA in November 2002 for the treatment of postmenopausal osteoporosis in women and subsequently approved for use in male patients, and has since been approved by the relevant authorities in Europe and elsewhere. Teriparatide has been used for 10 years in the United States, and the efficacy and safety of the drug were systematically evaluated in the text through key fracture trials, eight clinical trials and several Meta-analyses, and the overall conclusion was that teriparatide reduced the risk of osteoporotic vertebral and non-vertebral fractures in postmenopausal women. Trials of teriparatide in male patients showed increases in lumbar spine BMD of 5.9% to 13.5% and femoral neck BMD of 1.5% to 2.9% at 11 and 18 months of use, respectively. Studies of glucocorticoid-induced osteoporosis, the most common form of secondary osteoporosis, have found that teriparatide’s pro-bone anabolic properties are well suited to counteract the skeletal damage of glucocorticoids. In addition, there is another exciting study for orthopedic surgeons, animal studies have shown that teriparatide can facilitate fracture healing by stimulating and accelerating the formation of hard bone scabs and increasing the strength of the fracture site, and in clinical observations it has been found to accelerate fracture healing in the radius, hip and pelvis as well. In clinical practice, the author also found that in three cases of osteoporotic patients who had been bedridden after hip fracture due to limb hemiparesis, the fracture end had abundant bone scab growth after using teriparatide for 4-6 weeks. There were 4 patients with vertebral canal decompression vertebral implant fusion who had good bone scab growth and high fusion at the implant after using Teriparatide for 6~8 weeks. When orthopedic surgeons deal with osteoporotic fractures and internal fixation of the vertebral body due to degenerative changes in the cervical and lumbar spine, the most important concern is the holding power of the sparse bone on the dowel, thus extending the methods of hollow dowel with bone graft, bone cement infusion and surface coating of the dowel, but their efficacy has yet to be evaluated by long-term follow-up. If there is more evidence from randomized controlled trials to confirm the efficacy of teriparatide in promoting bone healing, it will be a great benefit to patients with osteoporotic fractures, accelerating fracture end healing and bone graft fusion in the near term, and increasing bone strength and reducing the incidence of secondary fractures in the long term by promoting bone anabolism and improving bone microarchitecture. Most of the concerns about the safety of teriparatide originated from the rat toxicity data, which clearly showed that the occurrence of osteosarcoma in rats is significantly dose- and time-dependent, i.e., the duration of drug administration is 2 years, which accounts for the majority of their life span; and the dose of drug administration is high, 3-58 times of the human dosage. No malignant bone tumors have been reported in human clinical trials of teriparatide, and the cumulative number of patients observed in these trials exceeds the planned 6,000 cases, with up to 3 years of continuous treatment. The first case of osteosarcoma with teriparatide was reported in 2007, followed by two other cases, but neither provided strong evidence of a direct relationship between teriparatide treatment and osteosarcoma development, and these rare cases of osteosarcoma were consistent with the epidemiology of osteosarcoma in adults, whose incidence was similar to the odds of developing osteosarcoma in the adult population without teriparatide use. Because many tissues and solid tumors are capable of expressing PTH/PTHrP receptors, it is recommended that patients with a history of cancer within the past 5 years avoid treatment with PTH. Several studies have confirmed a transient mild increase in blood calcium levels 4-6 hours after teriparatide administration, the incidence of which is 11%, and less than 1% of recurrences of hypercalcemia and hypercalciuria, while the incidence of hypercalcemia is significantly higher in patients with moderate renal insufficiency (GFR 30-49 ml/min). In actual clinical application, many experts recommend that blood and urine calcium levels should be tested before using teriparatide; daily calcium supplementation should not exceed 500 mg when using teriparatide. similarly, teriparatide should not be used in patients with hypercalcemia of any cause. No clinical manifestations of any increased risk of hyperuricemia, such as gout, kidney stones or arthralgia, have been identified in any of the relevant trials.