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Forteo (teriparatide) followed by HRT: My Experience
Osteoporosis & Bone Health | Last Active: 9 hours ago | Replies (102)Comment receiving replies
Thanks so much for sharing these amazing results. You must be so very pleased!!!
If I’m reading your chart correctly, your biggest gain in bone density was after introducing BHRT.
I’m curious to know if your endocrinologist attributes the high gains in bone density after going on estrogen to the hormone replacement itself or to the calcification of the collagen laid by Forteo a year or two earlier? My endocrinologist said it can take years for the collagen produced by teraparatide to calcify, so she preferred me not to get a DXA at year one of being on teraparatide and she hasn’t even ordered one for my year 2 follow-up visit in April! I had to get my GP to order it.
I’d love to go on BHRT after finishing my two years of Osnuvo (the Canadian bio-identical to Forteo), but since I’m 18 years post menopausal at the age of 66, I’m a little reticent since I have minor calcification in one artery. My cardiologist says the biggest risk with hormone replacement is a pulmonary embolism (not that it is a big risk), but he felt that there are so many good osteoporosis drugs out there, it might be best not to fool around with BHRT at this age and stage. I’m not sure I agree, but I’m a little frightened as my GP says estrogen can stimulate cancer.
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Thanks lynn59! Yes, I was pleasantly surprised, and a bit amused, by the size of the BMD gains at different stages, especially during HRT (you are right, major improvements).
My endo hasn’t gone over the full DXA with me yet, but your endo is absolutely right: mineralization takes time. From what I’ve read, the new osteoid formed under Forteo begins mineralizing fairly quickly, though full mineralization can take 3–6 months.
A large part of my BMD gain during the first 1–6 months on HRT might reflect both ongoing mineralization and an extended anabolic window when transitioning from Forteo to HRT - a concept I learned from an endocrinologist familiar with anabolic-to-antiresorptive (including estrogen) transitions. The degree of TBS improvement during Forteo highlighted its ability to rebuild bone microarchitecture, while estrogen, by contrast, being mainly antiresorptive, had some but limited effect on TBS.
Deciding on HRT can be challenging, and it really needs to be individualized. I also have mild coronary artery disease (CAC score 38), but both of my cardiologists didn’t consider me at increased risk. The risk of venous thromboembolism (VTE) with transdermal estradiol plus micronized progesterone is very low. Breast cancer risk is real, though the absolute risk with current bio-identical therapy isn’t fully defined. As with any treatment, each of us has to carefully weigh the risks and benefits before deciding. You might want to seek second opinions for a thorough risk assessment.
If you’re comfortable, any updates on your post-Forteo approach or DXA results would be great to hear, it might help others considering different options.