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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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I’m scheduling my bone density scan tomorrow and then I can share the results from the Raloxifene. I had zero issues with Raloxifene.
I just switched to HRT after having a conversation with my gynecologist. Studies show that HRT provides greater increases in bone density.
However, I’m concerned about the conflicting info regarding dementia.
@broken13 I’m scheduling my bone density scan tomorrow and then I can share the results from the Raloxifene. I had zero issues with Raloxifene.
I just switched to HRT after having a conversation with my gynecologist. Studies show that HRT provides greater increases in bone density.
However, I’m concerned about the conflicting info regarding dementia that I stated in another post.
I just listened to a podcast by Dr Kelly Casperson and Dr Corinne Menn on a recent paper titled, “Is it time to revisit the recommendations for initiation of menopausal hormone therapy?”
Written by Sasha Taylor, MBBSa ∙ Prof Susan R Davis
The data was very favorable for us boomers past the 10 year mark and over 60 years old.
Summary
Findings from the Women's Health Initiative studies led to menopausal hormone therapy (MHT) guidelines generally recommending the initiation of MHT be limited to women within 10 years of their menopause or before the age of 60 years. This recommendation has led to women who experience troublesome menopausal symptoms and who have not commenced MHT within these limits often being denied this type of therapy. Similarly, the majority of women who might benefit from the protective effects of MHT against bone loss and fracture are not offered this treatment option if they do not fit with these criteria. Based on review of the evidence that led to the conditional initiation of MHT, and subsequent studies, we propose that the recommendations regarding the initiation of MHT need to change to be more inclusive of women outside these chronological limits.
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5 Reactions@hansen2015
Excellent!!
@hansens Thank you. Looking forward to your results! Raloxifene was so simple for me and covered by my health insurance. I have some hesitation about HRT and would be very curious how the switch for you impacts on your bone density stability. Such a challenge navigating this process! Seems we are all having to do our own research as each doctor seems to have their own prescriptive path. And I know from working in the health care system, many times that is influenced by Pharma care kick back. Right now the push is on Evenity, when yet, there have been good history, research and results on Tymlos and Forteo.
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2 Reactions@mayblin These results are stunning and so encouraging! Thanks you for posting them. You must be thrilled! If I understand correctly, it appears you continued to gain from spine -2.9 to -1.9 after 15 months on BHRT without reclast or other bisphosphonate, and your CTX reduced to 110-130 pg/ml six months after starting BHRT. What was your CTX prior to to the BHRT? As I recall you have never fractured. Our histories are very similar with my DEXA score two years ago at spine at -3.5. I later started the same dose of BHRT as you around the same time at age 67, 13 years post menopause. As I previously posted, my recent CTX showed a 90% drop from 688 pg/ml to .99 after 14 months on BHRT. I am hopeful looking at your amazing results that I may gain a little more BMD still as my REMS showed an increase from -3 to -2.6 after 10 months on BHRT. I will post my next DEXA/TBS results. It is good to know that the Forteo worked well for you should I need to take it. Thanks again for sharing and congratulations!
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5 ReactionsOk all, I need a definition of the acronyms. Tech acronyms I get😂
BHRT - Bio identical Hormone Replacement
DEXA Scan - Dual Energy X-Ray Aborptiomegtry
TBS -?
CTS - ?
BMD - Bone Mineral Density?
REMS?
Thanks!
@hansens
TBS: Trabecular Bone Score
CTX: C-terminal telopeptide of type I collagen, or C-telopeptide
BMD: you got it
REMS: Radiofrequency Echographic Multi Spectrometry, some ppl may call it Echolight
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1 ReactionThanks so much Debbie, your kind words mean a lot!
I’m glad you asked about the details - I think they’re important. My CTX was 793 at the end of Forteo, showing a high-turnover state, though I’m not sure how much that drove the improvements. I transitioned directly from Forteo to HRT without a bisphosphonate, and my T-scores continued to rise: lumbar spine –2.9 to –1.9, with other sites also improving over 15 months on HRT.
While estrogen isn’t a bone builder by itself, it helped maintain and even add to BMD gains in my case. My P1NP was still high at the end of Forteo, carrying into the HRT period. Between the last two DXA scans (month 7 thru 15 on HRT), I also used three leftover Forteo pens alongside HRT, which may have contributed to additional gains (lumbar +5.3%), even though CTX was 110–130 and P1NP had a notable percentage rise despite a small absolute change (25 to 33)
These data are fascinating. As more women use HRT, we’ll learn a lot about how it interacts with anabolic therapy in different sequences or combinations.
I’m looking forward to seeing your new DXA results with TBS! Fingers crossed!
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3 Reactions@mayblin Thanks! I pulled up my DEXA scans and all I have are summaries with the numbers. Apparently, I need to ask for the complete report.