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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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@drsuefowler Would you mind sharing where you heard that Progesterone may increase osteoblasts. This is the first I have heard of this and would love to learn more. My understanding is that women who still have a uterus must take Progesterone when taking Estrodot. I am currently taking 100 mg of micronized progesterone nightly combined with small dose Estrodot patch, also prescribed by my functional physician and have had a small increase in BMD over a 10 month period. My physician said that the BHRT would stop the bone loss and may provide some small gains, but if so I would need to remain on it to maintain the gains. She didn't explain the reason for possible small gains.
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2 Reactions@broken13 Yes I am. I just had my bone density scan this morning and will share with the group once I receive the results. I will include before treatment, after Teriparatide for 2 years, and Raloxifene for 2 years.
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2 Reactions@hansens Did the Raloxifene hold your gains? Just wondering why you switched to HRT.
@debbie1956, I first heard this from my functional physician. I then found a study in the Journal of Osteoporosis titled, Progesterone and Bone: Actions Promoting Bone Health in Women. The authors wrote that "Estrogen and progesterone collaborate within bone remodeling on resorpsion (estrogen) and formation (progesterone)". @maybin has posted on this website that she has had very good improvement on with HRT.
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1 Reaction@hansens I like your logic! What natural human hormone does Teriparatide mimic? I looked online the there is a vegan product that attemps to produce collagen which was of interest since I don't eat meat.
@tillymack If is a synthetic form of the naturally occurring human parathyroid hormone.
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2 ReactionsThank you! Do you know what human parathyroid hormone does for the body, especially with regard to bones? Is human parathyroid hormone secreted normally for the benefit of bones and is this substance from Forteo adding more of the same / similar to what would naturally be there? Thanks again!
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1 Reaction@tillymack
Parathyroid hormone (PTH), made by parathyroid glands in the neck, keeps blood calcium levels stable. When blood calcium level drops, the parathyroid gland releases PTH, which causes release of calcium from bones, helps the kidneys retain calcium, and boosts absorption of calcium from food. Too much PTH over time, as seen in hyperparathyroidism, can lead to increased bone resorption, weakening bones and increased fracture risk.
Forteo (teriparatide) is a lab-made fragment of PTH (amino acids 1–34) approved for osteoporosis treatment in 2002. Research in the 1970s by a British scientist showed that intermittent (short, spaced-out) dosing of PTH could stimulate bone formation in mammals. This led to the development of synthetic PTH 1–34 or teriparatide, trademarked and marketed by Eli Lilly as Forteo.
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4 Reactions@mayblin Thanks so much for your excellent reply!
@mayblin I am on Teriparatide and will do the full 18 month course. Prior to this I took Forteo in 2016, one shot of Prolia and then 5 years Raloxifene . I am planning to go back on Raloxifene. It would be very helpful to Osteoprosis treatment if someone would gather research on second courses of Forteo/Teriparatide as this appears to have the least side effects and has done well for me. My endocrinologist is really pushing follow up with Evenity, but why change a good recipe? I had 13 compression fractures prior to treatment with Forteo and have not fractured since.
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