Forteo (teriparatide) followed by HRT: My Experience

@hansens
Can I ask why you're concerned about HRT and dementia? Thank you!

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.

I just wanted to comment on my endocrinologist appointment yesterday. I am 20 years past menopause. I was scared that I was going to get fired for going on bioidentical HRT against her recommendation. Of course, she recommended Evenity, Reclast or Prolia after my Forteo and half dose Tymlos. When I told her that I was taking 14mcg Menostar (estradial) with 40mcg Tymlos, she was OK. She said, "HRT that works. You just have to be careful about breast cancer and blood clots. Your DEXA is really good and your bone markers have improved".

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.

@drsuefowler Please keep us posted on what you plan to use after completing Forteo/Tymlos. If you plan to continue with HRT, will it be the same dose?

Very interesting info…thanks.

@mayblin, I hope to stay on the same dose of estrogen once I finish the half dose of Tymlos probably in February. My functional physician who prescribes the estrogen patch seems to think that I am supposed to take more to help bones. So we'll see what happens. She still wants me to take progesterone, and there is some thought that it increases osteoblasts. My endo said I didn't need it though. I just started trying to take the capsule every other night.

@tillymack Because the data is so conflicting. However, with the new analysis of the WHI report and other positive studies, I decided to take the risk.
Additionally I was on birth control until I was 55! My gynecologist suggested I stay on it to help with menopause and I didn’t have issues with birth control. The level of estrogen is much higher and a lot riskier in many aspects.
When I was off BC, my gynecologist didn’t offer me HRT and that is when the bone density started to drop.
I’m 14 years post menopause and just turned 69. 2 years on Teriparatide and 2 years on Raloxifene. I pushed my gynecologist again in September for HRT for bones and she said yes. She didn’t push back this time.
Since Raloxifene is an estrogen receptor drug, I was technically on estrogen… My logic! 😃

@hansens I like your thinking! I'd go on HRT given if given half a chance! I was on Raloxifene for decades but switched to Reclast when my spine dropped into osteoporosis territory. By the way, I've decided not to continue Reclast because of side effects.

@tillymack When you look at all the side effects of any osteoporosis drug it is overwhelming and scary. You think why would anyone take this drug…. My logic during this journey has always been to select a drug closest to what my body produces. Teriparatide a synthetic form of natural human hormone, Raloxifene an estrogen receptor, and now HRT.
I know this doesn’t work for everyone. This is just how I think and my need to have a framework.
I’m also taking collagen every day and anxious to see who this helps my bone density. It has Fortibone (bone), Verisol (skin, hair and nails), and Fortigel (regeneration of joint cartilage) by Gelita. Their clinical studies have great results. My nails are stronger and my hair is thicker.