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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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@broken13 I am convinced, doctors practice medicine by not just what they learnt in school or in practice but also by their own convictions of what will work best for their patients. You could be a perfect example of that theory. Even though Forteo was labelled by FDA as a one- time (for two years) in life drug, doctors are deciding on their own, which of their high fracture risk patients will benefit from a second round of Forteo. I believe FDA now has removed the once in life for two years only Forteo label for namely the high fracture risk patients (as dictated by their bone - turnover markers, dexa scans and other assessments) to be given under careful supervision. You did mention they can no longer do bone density on your spine. Based on your current Femoral Neck & Hip T- scores, you do fall in the high fracture risk category. Additionally, with a previous fracture you are probably a good candidate for the second Forteo treatment (as decided by your physicians). Best of luck!
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2 Reactions@tpinheiro29 I have looked and not found anyone doing any stats or research on outcomes of those of us who are using Forteo/Teriparatide a second time. I would think this would be valuable information. My plan would not cover Evenity, but did cover Forteo for second time "as it was proven to work before". Evenity has offered drug to me at 1/2 price, but I am so worried about side effects it mentions and have been reported on this site. I also have autoimmune disorder, so would be interested in anyone else with that and using Evenity. I have gone 10 years without fracture since Forteo, so more siding to repeat that recipe with Evista as follow up because at least I know it worked and willing to boost with Forteo again if needed.
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1 Reaction@broken13 .... Maybe, Forteo was a better choice for you the second time around. In Forteo, specific autoimmune contraindications are not noted vs in Evenity the autoimmune systemic inflammation could influence cardiovascular risk. That's something new to worry about which is best avoided.
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2 Reactionswonderful post, and well written, thank you
Would you consider copying and placing it in Inspire Osteoporosis and Hot Mama's community.
Here I believe is the link to the osteoporosis community and from that page you can reach the Hot Mama's community.
https://www.inspire.com/groups/bone-health-and-osteoporosis/
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2 Reactions@tpinheiro29 Thank you for that information! It gave me a lift and more confidence that I made the right choice. So hard navigating these serious drugs as often individual health risks are not fully considered in terms of side effects and success. Long term side effect risks seem not to be noted with Evenity, yet reported in comments on this site. At least with Forteo, I know any initial side effects passed and I felt great once completed treatment.
Hi Mayblin. I was so interested in your post. I am 67 and my dr wants to start me on Forteo. I have just started a transdermal estrogen only patch but dr says it is not enough. My hips are -3.3. I am afraid of the bisphosphonates and was wondering if I continue the transdermal estrogen if hopefully that would be enough to maintain my possible gains from Forteo. I understand that ur not a dr but you seem to be knowledgeable in this area and have experience with the drugs so I thought I would try and ask you what your thoughts were. I appreciate any help or suggestions that you may have. Thank you! : )
@goseve
Estrogen is an antiresorptive so it can help slow bone loss and may help maintain gains after an anabolic like Forteo, depending on the individual. In my case, i used estrogen for maintenance after Forteo, and so far, so good.
With a hip Tscore around -3.3, many doctors may feel estrogen alone isn't enough as a starting therapy, even though it may still play a role later on. That's likely why your doctor is recommending Forteo.
If you do decide to go ahead with Forteo, it may be worth asking your doctor how they usually handle estrogen during anabolic treatment - whether it's continued, adjusted, or timed differently, so you're clear on the overall plan from the start.
Please keep us updated and good luck!
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2 Reactions@mayblin
Thank you so much Mayblin! I appreciate your help.
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1 Reaction@goseve
For many postmenopausal women under especially 60, Hormone Replacement Therapy (HRT) can be an effective option to maintain bone mineral density (BMD) gains made after a course of Forteo (teriparatide), as noted by the Royal Osteoporosis Society (ROS) and other experts. While bisphosphonates are traditionally used, studies indicate HRT provides comparable fracture reduction and acts as an effective, safe, and inexpensive treatment for bone preservation in younger postmenopausal women.
Some research:
https://pmc.ncbi.nlm.nih.gov/articles/PMC4702457/).
https://pubmed.ncbi.nlm.nih.gov/11341338/
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2 Reactions@kathleen1314
Thank you Kathleen. I am hoping I can preserve the bone that I have. My insurance doesn't want to approve the Forteo for me. My numbers are bad but I dont have Medicare Part D so I am having a very difficult time getting approval. I worked in NYC and now live in Texas and I get my meds from my Union. I am told they want me to try Fosamax first but I've read that you should start on a bone builder first and then go on a bisphosphonate. I am so worried bc I have bilateral hip replacements and my ortho surgeon says that if the weak bones cannot hold the replacements, there isn't much that can be done and I will be in a wheelchair. I am so afraid. Osteoporosis is a progressive disease and I am thinking it's just a matter of time that my hip replacements willvdetach from my weak bones. : (
Well, thank you so much for your help.
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