<p>Osteoporosis is a major public health concern that occurs most commonly in postmenopausal women. The condition leads to decreased bone mineral density (BMD) and poor bone structure, which consequently increases the risk of fragility fractures (FFs). This process commonly stems from an imbalance in bone formation and resorption. Although antiresorptive therapies, especially bisphosphonates, are typically prescribed to reduce FF risk, the subcutaneous parathyroid analogue teriparatide, which stimulates bone formation, is more effective in reducing this risk. Teriparatide increases hip and spine BMD and reduces both vertebral and non-vertebral fracture risks. Although effective as monotherapy, teriparatide shows synergistic benefits when combined with denosumab or zoledronate. Teriparatide is well tolerated, with early safety concerns around osteosarcoma alleviated by long-term observational data and labelling updated accordingly. Data also suggest teriparatide is effective for the treatment of many off-label indications, such as non-union fractures and osteonecrosis of the jaw. Because of its unique mechanism of action, with plateauing of BMD gains after prolonged treatment, there is a 2-year prescribing limit set by the European Medicines Agency. Immediate sequential antiresorptive therapy after teriparatide is recommended in every patient. In patients previously exposed to bisphosphonates, the anabolic response to teriparatide is attenuated, particularly in the hip, likely due to prior suppression of bone remodeling. First-line use of teriparatide in Italy, however, is restricted to patients at very high fracture risk. A recent expert consensus suggested that the efficacy, safety and increased affordability of teriparatide support its use in a broader range of patients with FFs.</p>