Forteo (teriparatide) followed by HRT: My Experience

@drsuefowler

Yes. I take progesterone, estradiol testosterone pellet ang vaginal estradiol cream. Hysterectomy 9 years ago. Started bhrt at 76 now 77. I just started a new thread under womens health re: benefits of testosterone.
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@drsuefowler: No, a doctor never had suggested I take progesterone telling me I didn't need to because of the hysterectomy. No uterus-no need. Adding progesterone is to protect the uterine lining from hyperplasia due to estrogen alone so that's a moot point if you don't have a uterus to protect. And I probably saw at least three gynecologists over the years due to retirements in the ob/gyn office and none ever suggested progesterone. I was also told, but this was years back, that data from the Women's Health Initiative Study suggested that estrogen alone (ERT) didn't significantly increase one's risk for breast cancer but combining estrogen with progesterone (HRT) did. Maybe your functional physician is trying to unnecessarily balance your hormones but I say go with your gut, especially if, like you say, you've had issues with the progesterone capsule and cream. Besides, if you still have your ovaries, you're probably still producing some progesterone.

@mkoch, I am in a similar situation to you, but I am still on a half a dose of Tymlos with my estrogen patch. I also have had a hysterectomy, but I still have my ovaries and cervix. My functional physicians want me to take progesterone and my pharmacist also suggested it. Has any medical person wanted you to take progesterone even though you have had a hysterectomy? I have had issues with the progesterone capsule and cream. I feel fine on just the estrogen. Thanks for posting. It is very encouraging that the estrogen helped you keep your gains.

@psmnonna I'd like to do that as well. What kind of MD started you on BHRT?
Thank you!

@mayblin: I've only had DEXA scans every 2 years since I was in my forties. (73 now) My endocrinologist has NEVER mentioned bone turnover markers; I've learned about this only recently from this forum. My intent is to bring it up to her on my next visit. When I was on forteo, in my 50s, it had a black box warning and thus I was told that one was only allowed to be on it for 2 years b/c the long term effects weren't known. So when I finished my 2 years, and was taken off of forteo, my doctor wanted me to go on Prolia. But it had only been on the market for 2 years and I declined. Like I said, I kept my gains on estrogen, a very low dose patch of .025. After 15 or so years on the low dose estrogen patch I got breast cancer, stage 1. At this point I'd like to say both my sisters also got breast cancer ( though none of us tested positive for the BRCA gene) and one of my sisters was never on estrogen replacement therapy. And, the gynecologist who prescribed the estrogen patch told me studies showed that estrogen therapy alone (without progesterone) didn't significantly raise one's risk for breast cancer. But, alas, the oncologist wanted me to stop taking it. That's when I finally relented to go on Prolia. I was fine for 5 years on it, but got sick and ended up in the hospital with sepsis from a bladder infection shortly after being injected with a Prolia copy-cat drug, Jubbonti, that's only been on the market for 3 months as my health care organization switched b/c they could get the copy-cat biosimilar at a cheaper price. By the way, if one is so inclined, there is a great study on the National Institute of Health's library that clearly states 1 in 33 recipients on Prolia (and by extension one can include Jubbonti as it has the same active ingredient) get a uti after receiving the drug and 5% develop pneumonia. Of course, all drugs come with side effects and it's a risk to benefit decision. In my case, after 5 years on Prolia with no side effects, I refuse to have the copy-cat version, Jubbonti, injected into my body again. Now that I have learned on this forum that one is not limited to forteo for only 2 years, I am going to consult with my oncologist about taking this anabolic again. Since it is a bone building drug, I want my doctor's opinion if there's an outside chance it could in any way wake up any possible dormant cancer cells. My preference would be to go back on forteo. If I am advised not to, my next step is to have my endocrinologist try and get an exception for me to stay on Prolia rather than the new Jubbonti drug. If I don't get the exception, I will try and find an independent endocrinologist who isn't part of a corporate health care system and is therefore not bound by their prescribing constraints.

@mkoch Thank you very much for sharing your story, it’s so valuable to hear a long-term perspective. Forteo followed by estrogen clearly worked very well for you in maintaining Forteo gains for many years. I’m sorry you had to face breast cancer and stop estrogen - it really highlights how important it is to weigh risk versus reward and to keep monitoring over time.

From what I’ve read, after long-term Prolia treatment, switching straight to Forteo hasn’t worked well in clinical trials, with BMD often decreasing. Definitely worth discussing carefully with your doctor. Please keep us posted. Your experience gives the rest of us a lot to learn from.

@mayblin Is it your understanding that Prolia is best followed by Reclast?

@tillymack yes; from what I’ve read Reclast is the go-to drug for managing Prolia rebound, though in some cases oral bisphosphonates like Fosamax can be considered based on a patient’s risk profile. Risk is influenced by many factors, including number of shots received, fracture history, overall fracture risk, bone density at stopping, and other individual considerations. In very high-risk patients, endocrinologists may monitor CTX to help guide the timing or frequency of Reclast infusions.

There’s a small study of 2 Prolia shots followed by Evenity, focused on BMD improvement but not powered to show rebound prevention.

Professor Langdahl has an excellent YouTube talk on managing Prolia discontinuation for anyone interested.

@tillymack
I was told a resounding no to HRT by 3 endos and my rheumatologist. After lots of research I decided to clear some hurdles on my own. I saw a cardiologist and had a stress test done (actually 2 stress tests), a cardiac ultrasound and an artery scan to rule out any underlying cardiovascular issues that I may not know about. All was clear and my artery scan showed 0 placque buildup. So with that info, I found an OBGYN who deals in hormone replacement therapy and scheduled a visit with her. I was able to be prescribed HRT because even after 25+ years I still have vasomotor symptoms and insomnia with waking multiple times a night. That all started in my late 30s and still happening! She prescribed a low dose of both estradiol and progesterone to start with.
It all took lots of time to find the right Drs and also some winging it on my own. Maybe try looking to OBGYN or even urologists in your area. Kelly Casperson has some great Youtube videos on HRT and she is a urologist. Look her up and watch. Very informative stuff!
Good luck!