OBJECTIVES: To evaluate the association between persistence on teriparatide (TPTD) treatment and fracture incidence rate and fracture risk among US patients. METHODS: We used the Thomson Reuters MarketScan® Research Databases, 2004-2008, to identify new TPTD users≥18 years with continuous medical and pharmacy coverage over 12-months pre-index and 24-months post-index date (index date=first TPTD prescription). Pathologic fractures, traumatic or clustered fracture events (>3) occurring within 7 days, fractures within 90 days of index date or at the same site, and any hip fractures after 2nd occurrence were excluded from the post-index osteoporotic fracture definition. Persistence was measured as total days on TPTD until first 45-day gap. Logistic regressions were performed to model fracture risk for any fractures (AF), hip fractures (HF), vertebral fractures (VF), and non-vertebral fractures (NVF) separately, controlling for patient characteristics, insurance type, health care provider type, Charlson comorbidity index score, pre-index bone mineral density test, medication use and fracture history. RESULTS: Among the 3587 new TPTD users (mean age = 68.9 years; 91% female), adjusted incidence rates per 1000 patient years by fracture type (for persistence groups 1-6 months, 7-12 months, 13-18 months, 19-24 months) were:  AF 103.09, 78.17, 72.68, 59.31; HF 6.87, 6.11, 4.30, 3.76; VF 26.29, 15.62, 11.55, 9.57; and NVF 70.90, 60.29, 60.24, 48.60. Fracture risk was significantly higher for persistence ≤6 months versus 19-24 months in all fracture models (OR=1.75 [AF], 2.67 [VF], and 1.41 [NVF]), except for HF (OR=1.95, p=0.078). Other significant risk factors included: older age (HF (OR=1.06, p=0.001) and VF (OR=1.04, p<0.001); previous anticonvulsant use (VF (OR=2.20, p<0.001), VF (OR=1.79, p<0.001)); previous immunosuppressant use (NVF (OR=1.54, p=0.013)); and pre-index fracture (AF (OR=1.37, p=0.005); NVF (OR=1.71, p<0.001)). CONCLUSIONS: Among US teriparatide patients, fracture incidence rates and fracture risk decreased as persistence increased for any clinical, vertebral, and non-vertebral fractures.