Abaloparatide: osteoporosis treatment, dosing, and side effects
Last updated September 6, 2026.
**Abaloparatide is a bone-building (anabolic) osteoporosis medicine given as a daily injection under the skin, and it belongs to the parathyroid hormone related peptide (PTHrP) analog class.** It works by signaling the cells that build new bone to work faster than the cells that break bone down, so bone density rises and the risk of spine and other fractures drops. The most important safety point is the time limit: total lifetime use of abaloparatide plus any other parathyroid hormone or PTHrP medicine, such as teriparatide, should not go past 2 years, and you will usually move to a different bone medicine after that so the gains hold.
What does it treat?
Abaloparatide is approved for postmenopausal women with osteoporosis who are at high risk for fracture, and for men with osteoporosis at high risk for fracture. High risk usually means you have already broken a bone from a minor fall or a cough, your bone density T score is very low, or you kept losing bone or fractured while taking a bisphosphonate such as alendronate. It is also used for people who cannot tolerate other osteoporosis medicines. It is sold under the brand name Tymlos and comes only as a single-ingredient pen, so there are no combination products, though almost everyone taking it is also told to take calcium and vitamin D. Abaloparatide is not a painkiller and does not treat the ache of an existing fracture, and it is not used for osteopenia alone or for bone pain without osteoporosis.
How do you take it?
Abaloparatide comes as a prefilled pen that you inject under the skin of the abdomen around the navel, rotating the exact spot each day. The adult dose is 80 mcg once daily, and that 80 mcg per day is the ceiling; taking two doses in one day does not build more bone and raises your calcium level. Each pen holds 30 doses. Keep an unused pen in the refrigerator, then after the first injection keep it at room temperature and throw it away 30 days after first use even if medicine is left. Food does not matter, so you can inject at any time of day, but pick a consistent time and take your calcium and vitamin D as directed. Sit or lie down for the first several doses, because some people get lightheaded within 4 hours of an injection. If you miss a dose, inject it later the same day if you remember; if the day has passed, skip it and take the next dose at your usual time, and never double up. Call your doctor before your next dose if you faint, if you get nausea with vomiting, constipation, deep muscle weakness, confusion, or heavy thirst and urination, or if you have flank pain or blood in your urine.
Side effects to know
- Common: Most people notice dizziness or lightheadedness in the first few hours after a dose, along with redness, itching, or swelling where they injected, and some get nausea, headache, palpitations, or fatigue, all of which tend to settle over the first few weeks.
- Serious: Stop and get medical help for fainting or a near faint, for signs of a high calcium level such as vomiting with constipation, muscle weakness, confusion, or unusual thirst and urination, and for kidney stone symptoms like sharp flank pain or blood in the urine. Get emergency help for signs of a serious allergic reaction, including hives, swelling of the face, lips, or tongue, wheezing, or trouble breathing.
Who should not take it?
Do not use abaloparatide if you already have a high blood calcium level or overactive parathyroid glands, since the drug pushes calcium higher. Talk with your doctor first if you have had radiation to your bones, cancer that has spread to bone, Paget disease of bone, an unexplained high alkaline phosphatase level, a history of kidney stones, or kidney disease, and tell your doctor if you take digoxin, because a rising calcium level can make digoxin toxic. There is no separate dose adjustment for most other medicines, but bring your full list, including calcium and vitamin D supplements and thiazide diuretics, which also raise calcium. Abaloparatide is not for use in pregnancy or while breastfeeding and is not indicated for women who could become pregnant, so tell your doctor if you are pregnant, planning pregnancy, or nursing. Alcohol has no direct interaction, but it adds to the lightheadedness after a dose and raises fall and bone loss risk, so keep intake low and avoid drinking in the hours right after you inject.
When is it an emergency?
Call 911 if you collapse, cannot be woken, have chest pain, or have trouble breathing or swelling of the face, lips, or tongue after an injection, since that can be a serious allergic reaction. Call Poison Control at 1-800-222-1222 right away if you or someone else injects more than one dose in a day or a child gets hold of a pen; too much abaloparatide causes a high calcium level with vomiting, weakness, confusion, and a drop in blood pressure. Go to an emergency room for a faint that caused a head injury, for severe flank pain with fever or vomiting that suggests a blocked kidney stone, or for sudden severe back pain after a minor strain, which can be a spine fracture. If you feel a faint coming on, lie down with your legs raised and call your doctor the same day.
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Common questions
What is the maximum dose of abaloparatide I can take?
The dose is 80 mcg injected under the skin once a day, and that is also the daily ceiling. There is no higher dose that works better, and doubling up mainly raises your blood calcium and your chance of feeling faint. There is a second limit that matters just as much: total lifetime use of abaloparatide plus any other parathyroid hormone or PTHrP medicine, such as teriparatide, should not go beyond 2 years. After you finish that course, your doctor will usually start a bisphosphonate or denosumab, because the bone you gained is lost fairly quickly if nothing follows.
Can I drink alcohol while taking abaloparatide?
There is no direct interaction between alcohol and abaloparatide. The problem is that both can make you lightheaded, and abaloparatide already lowers blood pressure for a few hours after each injection, so drinking near your dose raises the chance of a fall. Falls are the main way people with osteoporosis break bones, so that matters more here than it would with most drugs. Heavy drinking also speeds bone loss on its own. Keep it light, and do not drink in the hours right after you inject.
Is abaloparatide safe during pregnancy or breastfeeding?
No. Abaloparatide is not indicated for use in pregnancy or in women who could become pregnant, and it should not be used while breastfeeding. Osteoporosis treatment in these situations is handled differently, and your doctor will stop the drug if you become pregnant. Tell your care team if you are pregnant, trying to conceive, or nursing before you start. If a pregnancy happens while you are on it, contact your doctor rather than simply continuing the daily injections.
Do I need to take abaloparatide with food?
No. Food has no effect on how abaloparatide works, so you can inject before or after meals at whatever time of day you will remember. Inject into the skin of your abdomen around the navel and change the exact spot each day to limit redness. What does need attention is calcium and vitamin D: the drug needs raw material to build bone, so take the amounts your doctor recommends, usually with food since calcium is absorbed better that way. Keep the pen in the refrigerator until first use, then at room temperature, and discard it 30 days after the first injection.
What are the signs of taking too much abaloparatide?
An extra dose pushes your blood calcium up and your blood pressure down. Watch for nausea and vomiting, constipation, deep muscle weakness, confusion, unusual thirst with frequent urination, and severe dizziness or fainting when you stand. Flank pain or blood in the urine can mean a kidney stone from the extra calcium. Call Poison Control at 1-800-222-1222 for any suspected overdose, and call 911 for collapse or trouble breathing. Do not take another dose to make up for confusion about timing; skip ahead to your next scheduled day.
What medicines interact with abaloparatide?
The interaction that gets the most attention is digoxin, because abaloparatide can raise blood calcium and higher calcium makes digoxin toxicity more likely, so your doctor will monitor you closely if you take both. Thiazide diuretics such as hydrochlorothiazide also raise calcium and can add to the effect. Blood pressure medicines and nitrates can stack with the lightheadedness in the hours after a dose. Calcium and vitamin D supplements are meant to be taken with abaloparatide, but stay at the dose your doctor set rather than adding more. Bring your full medicine list, including over the counter products, to each visit.