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Forteo (teriparatide) followed by HRT: My Experience
I wanted to start a thread sharing my experience with Forteo → HRT, since this treatment sequence is less discussed but may be very helpful for other women navigating osteoporosis.
I was diagnosed with osteoporosis at age 59. My lowest T-score was –3.4 at the lumbar spine, with hip and femoral neck in the osteopenia/borderline osteoporosis range. My endocrinologist ruled out secondary causes. Without a family history, postmenopausal estrogen deficiency seemed the most likely contributor, though low BMI, protein intake, and activity level/type may have played a role.
Shortly after diagnosis, I improved my diet and added weight-bearing exercise. I started Forteo (teriparatide) within a few months and continued for 22 months. P1NP was 137 µg/L at the end of Forteo.
At age 61 (11 years postmenopausal), I transitioned to HRT: transdermal estradiol 0.025 mg/day patches plus oral micronized progesterone 100 mg/day. It’s now been 15 months on HRT. CTX stayed 110–130 pg/mL after 6mo starting HRT.
Since the start of Forteo to 15 months on HRT, my results have improved as follows:
• Lumbar spine T-score: –3.4 to –1.9
• Total hip T-score: –2.2 to –1.7
• Femoral neck T-score: –2.5 to –1.8
• TBS: 1.264 to 1.34
All DXA scans were performed on the same machine by the same technician. Detailed DXA results, including percent changes from previous scans and baseline, T-scores, and TBS values, are presented in the attached spreadsheet if anyone is interested.
Between my last two DXA scans, I also used three leftover Forteo pens with off-label dosing.
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Note: I use the term “HRT” because it’s widely recognized. In medical literature, “MHT” (menopausal hormone therapy) is the standard term. In my case, I used regulated, body-identical estradiol and micronized progesterone, sometimes referred to as bHRT.
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Thanks for reading! I would love to hear your thoughts, experiences, and insights. Also please feel free to ask any questions.
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@singingbones
Great question! I’ll chime in with my thoughts but I’m also curious to hear how others figured out their dose.
For me, the main goal was to use estrogen’s antiresorptive effects for maintaining bone density after Forteo. My doctor kept an eye on bone resorption markers to make sure the dose was actually doing its job. I also requested an earlier DXA scan for assurance.
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5 Reactions@mayblin
Thanks for the information. I dont mind taking reclast. I will talk to him again about ctx monitoring and if he has a problem I will purchase it myself. Thanks again for your help.
I just got my bone marker results back after 6 weeks of a 14mcg estradiol patch and 40 mcg Tymlos. On 4/29/25 my CTX was 912 and P1NP was 179 (I had just changed from Forteo to a half dose of Tymlos). Now my CTX is 654 and my P1NP is 147. I am pleased that my CTX has gone down and I think the ratio is better? @mayblin is this a better ratio?
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4 Reactions@drsuefowler
That’s looking really good! Both markers have come down since you started HRT, which makes sense given estrogen’s antiresorptive effect. The greater percentage drop in CTX compared with P1NP suggests less resorption relative to formation - a positive shift toward anabolic activity.
It’ll be interesting to see whether the markers stay stable or continue to trend down as HRT reaches its full effect over the next few months.
How long are you planning to stay on Tymlos?
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1 Reaction@mayblin, thanks for your response. I have enough Tymlos to probably take half a dose until the end of February. I have appointments with my 2 endocrinologists this month. They will not be happy with me going my own way, but I am interested in their opinions. I hope I don't get fired!
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3 ReactionsI had similar positive results with Teriparatide. After Teriparatide I went on Raloxifene (Evista) for 2 years. I’m post menopause 13 years. My gyno had me stay on the birth control pill until 55years old.
I just convinced her to prescribe HRT for me based on the positive data for bones. I didn’t have any issues with Raloxifene and it is an estrogen receptor drug. I just wanted to take something closer to what my body produces naturally. Overall I’m in great health. Plus there are other positive benefits to HRT.
However, the controversial dementia studies do have me pause at times. Raloxifene doesn’t state dementia as a risk.
Any thoughts?
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1 ReactionThe dementia risk with HRT really depends on formulation, route, dose, age at start, and duration of use, among other factors. The WHI Memory Study - the largest randomized clinical trial (RCT) - linked oral conjugated equine estrogens (CEE) plus synthetic progestins (MPA, medroxyprogesterone acetate) to higher dementia risk, but that’s a very different regimen from the preferred transdermal estradiol with micronized progesterone used nowadays. The only RCT I’ve come across on that combo, KEEPS-Cog, found no cognitive harm, though it only studied early starters and short-term use (about 4 years). I think it’s fair to say the exact dementia risk with this bioidentical regimen remains unknown. I’m personally choosing to take that small, unquantified risk and keep reassessing as new data emerge, since osteoporosis is 100% my reality now.
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5 Reactions@mayblin Thank you! This is such a tough decision and it is keeping me up at night…. Do I continue the HRT course or go back to Raloxifene….
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1 Reaction@hansens
I understand and share your concern. While there are no solid RCT data to assess absolute dementia risk for women starting transdermal estradiol + progesterone later in life, a recent large observational study published in Menopause (2024) provides some useful insight:
https://journals.lww.com/menopausejournal/fulltext/2024/05000/use_of_menopausal_hormone_therapy_beyond_age_65.3.aspx
This study examined various menopausal hormone therapy (MHT) formulations in women over 65 and found that transdermal estradiol combined with progesterone was not associated with an increased risk of dementia. Low-dose, non-oral formulations generally showed the most favorable outcomes (Table 4).
While this is observational data, not a randomized trial, it’s somewhat reassuring that this formulation did not show an increased signal for dementia.
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4 Reactions@hansens Are you monitoring your progress with bone density scans? I stayed on Raloxifene for 5 years with no problem and hope to return to it again after this course of Teriparatide.