Forteo (teriparatide) followed by HRT: My Experience

@broken13 wow 13 compression fractures?? Makes no sense to change it since you didn't have a compression fracture done using Forteo.

@broken13 Forteo worked really well for you the first time - no new fractures is the best proof! There isn’t much data yet on retreatment, so it’ll be exciting to see how your second round turns out!

Your endo is probably thinking about Evenity if more bone building is needed to further reduce fracture risk, depending on your next DXA. If your BMD looks solid, then focus will likely shift to maintaining those gains with an antiresorptive.

Your Forteo -> raloxifene (and repeat) plan could work again if your endo feels it fits your situation. It really comes down to what your bones need next.

Good luck with your next steps and hope your DXA gives you reassuring results!

@jimmy05 Right? Why change what is working. I don't think she will agree with me though. I was due for a bone density this month, but now she says January and to have these things covered (medication and tests) we need a doctors referral for the insurance to cover it. So they do hold a lot of say/power in treatment options. Would love to hear outcomes for people having done second courses of Forteo/Teriparatide.

I received my DXA scan result. I was Teriparatide for 2 years and then Raloxifene for 2 years. Switched to HRT 1.5 months ago.
One other note, I don't have a score for my right hip. Reason I had a hip replacement 1 year ago. The hip was replaced due to a body design flaw 😄 ( rotated pelvis and hip is higher than left) and I wore it out from all the fitness I do. Nothing to do with Osteoporosis. I hope this helps!

Sept 16, 2021
1. Lumbar Spine osteopenia with a T score of -2.2 measured from L1 through L3.
2. Femoral osteoporosis with a left hip total T score of -3.0 and right hip total T score of -3.3.
3. Radial osteoporosis with a T score of -4.1.
The results started the treatment.

10/11/23 Results of Teriparatide - Huge improvement!
LOCATION: L1-L4 AP Lumbar spine
BMD in g/cm2: 1.361
T-Score: 1.5
Z-Score: 3.1 %
Change since prior study: +32.3

LOCATION: Left femoral total
BMD in g/cm2: 0.724
T-Score: -2.3
Z-Score: -1

LOCATION: Right femoral total
BMD in g/cm2: 0.683
T-Score: -2.6
Z-Score: -1.3
% Change in mean total femur since prior study: +14.7

10/13/25 - Raloxifene
Lumbar Spine -1.1
Left Femoral neck T-score -2.1
Left Femoral neck BMD: 0.749 g/cm2
Left total hip T-score -3.0

I lost some of the Teriparatide results.

@hansens Wow, your Forteo results are amazing - such huge gains at all sites! You must be thrilled with your progress.

It looks like some of those gains in your lumbar spine and left femoral total have dipped on Raloxifene, which isn’t too surprising since raloxifene is the weakest among all antiresorptives and, depending on the individual, sometimes isn’t enough to fully maintain Forteo gains. It’s also worth noting that, from what I’ve read, estrogen can take 6–9 months to reach its full effect. So checking CTX might be a helpful way to see how your dose is working going forward.

@mayblin I agree with you. I was told DXA scans aren’t too expensive. So I plan to pay out of pocket at the one year of HRT. Will also have CTX testing done-great suggestion.

@mayblin - I (F/72) have been following this Forteo/MHT thread even though I'm currently taking the Evenity injections. I have 8 mo remaining to continue my research into options other than another drug.

I've been on a low-dose Estradiol (cream) & Progesterone (oral) for many yrs, but am currently looking for a dr who will reevaluate in light of OP.

From what I've read, it seems that most are using a patch. My friend's patch to address OP is 0.75. My cream is 0.25. What methods & doses are you seeing effective enough to increase or hold the gains post drugs? I realize each person's body is different & there are many variables.

Thanks for allowing me to cut in on the Forteo discussion!

@singingbones

Thanks so much for bringing this up - anything about estrogen is absolutely relevant here.

From what I’ve gathered, among the three main forms of estradiol - oral tablets, transdermal patches, gels, or sprays, and vaginal creams, tablets, or rings (mostly for local effect) - transdermal patches generally provide the most consistent systemic hormone levels. Doses typically range 0.025–0.1 mg/day, with 0.05 mg/day being a common clinical standard. Meta-analyses show that bone benefits (maintain or increase BMD) are dose dependent.

I’ve found monitoring bone turnover markers like CTX helpful in gauging dosing adequacy.

Are you currently using MHT alongside Evenity, or did you stop before starting it? And just to clarify, is your cream vaginal or meant for systemic absorption through the skin?

If you’re thinking about MHT after Evenity, it’s important to review form, dose, timing, and monitoring with your endocrinologist. Estrogen usually takes 6–9 months to reach maximal CTX suppression (compared with ~12 weeks for oral bisphosphonates), so timing after an anabolic may affect how well resorption is controlled. The type of anabolic and individual response (to either anabolic or estrogen) can also make a difference.

Please share what you learn, it could help many of us gain insight from newer information and firsthand experiences.

@mayblin - I've been on the 0.25 vaginal compounded estrogen cream for yrs to address dryness (as well as 100mg oral progesterone). While I've been addressing supplements, exercise, etc., it's now time to review the hormone aspect in terms of OP. I've never stopped taking MHT.

No bone marker labs have ever been requested for me. I have since learned that I could have asked for them. However, they have been requested to be done at the end of the Evenity course by the orthopedic dr who is overseeing the drug process.

Based on my experience, neither my endocrinologist nor orthopedic dr nor PCP nor gyn have been helpful in addressing MHT. I have an HMO ins, so I pay out of pocket to see an integrative dr for hormones. My gyn is happy to renew prescriptions & submit lab requests from the integrative dr to save me money, but doesn't speak into the issue.

My local compounding drug store has given me a list of local drs who prescribe bio-identical hormones from them. That's where I'm at. That narrows down the list of possible drs to call. However, I want to go w/enough information/knowledge before I make an appt so that I can hopefully determine on the initial phone call as to whether or not the dr is treating OP w/MHT, as some seem more focused on peri-menopause.

The info your provided is very helpful & will be added to my notes. Thank you!

@drsuefowler WOW! I am 62 years old, also nearly 20 years past menopause and never took HRT. Regretting that now but figured no chance of starting it at this late point--but perhaps i should reconsider? In Osteoporosis land I had TERRIBLE dexa last year so went on Evenity straight away and now having to decide between Reclast or Prolia.