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Over 6M, LS aBMD increased by 5.5% (95% CI 3.83, 7.19) in teriparatide and 1.5% (95% CI -0.73, 3.83) in placebo (P = 0.007). There were increases in 3M BTMs, and BFR (cancellous and endocortical BFR between-groups P = 0.004). Over 24M, teriparatide increased LS aBMD by 13.2% (95% CI 10.3, 16.2), total hip by 5.2% (95% CI 3.7, 6.7) and femoral neck by 5.0% (95% CI 3.2, 6.7; all P ≤ 0.001). Serum N-terminal propeptides of procollagen type 1 (P1NP) and 3M endocortical BFR were moderately associated with LS aBMD response. Teriparatide was we