OBJECTIVES: Describe patient characteristics, health related quality of life and back pain in postmenopausal women with severe osteoporosis who are initiating teriparatide in France. METHODS: The European Forsteo® Observational Study, EFOS is a 36-month, prospective study evaluating fracture outcomes, back pain and health-related quality of life in postmenopausal women with osteoporosis initiating teriparatide. Patients were enrolled in Austria, Denmark, France, Germany, Greece, Ireland, The Netherlands, and Sweden. Design was non-interventional with all consenting patients in the course of normal clinical practice intiiating teriparatide being eligible for enrolment. QOL was assessed with the EQ-5D questionnaire, pain was assessed with the back pain questionnaire and a visual analogue scale (VAS). RESULTS: A total of 309 patients were enrolled in the study in France. The mean (SD) age was 74.5 (7.4) years. A total of 96.8% of patients had 2 or more fractures after 40 years old and 77.5% of the pre-existing fractures were vertebral ones. In 82.8% of cases, BMD T-score for lumbar spine, total hip and femoral neck was under -2.5. Back pain was frequently observed: 76.6% of patients stating that they had back pain every day or almost every day. Intensity of back pain was moderate to severe in 93.1% of cases. Back pain led to limitation of activities moderately or severely in 83.1% of cases. The corresponding mean (SD) visual analogue scale score for existing back pain in the last month was 56.2(24.9). Patients QOL was also deteriorated with a median EQ-5D health state value of 0.52 and 30.7% of patients reporting extreme problems with pain and discomfort and 15.5% reporting extreme problems with usual activities. CONCLUSION: The profile of the EFOS study cohort indicates that patients initiating teriparatide have severe osteoporosis associated with back pain impacting on usual daily activities and a poor quality of life.