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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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@gravity3 Which OP drug did you find most effective? Are you expecting to be taking prolia indefinately or maybe HRT will keep your bones stable?
@tillymack
Evenity gave me the greatest gains. I am still thinking about Prolia. I was going to change to one smaller dose of reclast rather than continue with the 3rd shot of Prolia but I had other health issues. My intention now is to make that switch in May. Then I may be able to take a drug holiday. I need to learn more about that.
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2 Reactions@mkoch According to my endocrinologist one can take Forteo for two years (and only ONCE in a lifetime). His intent is to best hold off on Forteo until or if a fracture happens down the road. In other words, don't use Forteo unless you have had a fracture or is a real high risk for Osteoporosis fracture (and can only use it once in your lifetime).
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3 ReactionsDid you have side effects with Forteo? I am afraid to try it because i cannot adjust the dose..I've failed every other osteoporosis drug with terrible side effects. I'm very small, and normal doses of meds are often too high for me.
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3 ReactionsSo you are off the drug now?
@tkdesign so you are off the drug now?
@tpinheiro29 I am using Forteo (Teriparatide) for the second time. Did Forteo for 24 months in 2016 after compression fractures in my spine. Have not fractured since, and now taking the Teriparatide for 18 months as a booster. No side effects. They can no longer do bone density on my spine, but Femoral neck and hip have shown improvement. Recent T-scores in Femoral Neck are -3.2 and Hip -2.8
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3 Reactions@tkdesign I am also very med sensitive, but pushed through as fractures were so painful. Initial side effect of some leg cramping and headache and tummy upset, but those past after a few weeks and well worth putting up with. I believe Forteo has the least side effects from what I have read and experienced, with the best benefit in building bone.
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1 Reaction@dvargo I didn't start yet
@tkdesign I'm sorry to hear that you're very medication-sensitive, that can definitely make starting a new medication more challenging.
When I was on Forteo, I experienced tiredness for the first 5-6 weeks, which is listed as a common side effect. In my case, the underlying issue seemed to be a drop in blood pressure (24/7), which improved with increased fluid intake and at times, salted water. For reference, I weigh ~115 lbs.
Forteo pens do have "clicks", but they don't correspond to fractional doses. As a matter of fact, the Forteo pens must be fully loaded or it won't deliver a dose. To my knowledge, the biosimilar teriparatide pens on the market aren't dose adjustable either.
Occasionally we hear about every-other-day dosing being used; my endo mentioned it as well - I'm sure there are good clinical reasons for it. That said, I'm not entirely sure about the consistency of the outcome from reduced dosing. Without a titratable pen, every-other-day dosing could potentially serve as a stepping stone toward full dosing to achieve therapeutic results - discuss with your doctor. Hope you're able to give it a try, and best of luck to you.
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