Connect
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.
⸻
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.
⸻
Thanks for reading! I would love to hear your thoughts, experiences, and insights. Also please feel free to ask any questions.
Like
Helpful
HugInterested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.
Connect
@goseve
Forgive me if you have discussed this before
What are your tscores, fractures? and have you seen a good endocrinologist to do all the tests to check for any conditions or diseases.
All that determines the best way to proceed.
There is absolutely no reason to fear a wheel chair, unless you do nothing. There are lots of good interventions nowdays.
What does your ortho surgeon suggest. That is the weakest point and where you are most concerned. Your hip replacements and keeping them healthy and strong are a priority.
Hips take a long time to change compared to the spine so I agree that you need an intervention that gives you the best chance of a quick, positive result.
Evenity (romosozumab) is widely considered the fastest-acting osteoporosis drug for increasing hip bone mineral density (BMD) and reducing fracture risk, often outperforming or acting faster than Prolia (denosumab) and Forteo (teriparatide). While Prolia is highly effective at increasing hip density, it works as an antiresorptive, whereas Evenity builds bone and reduces breakdown.
-
Like -
Helpful -
Hug
2 Reactions@kathleen1314
Hi Kathleen. I cant thank u enough for responding to me. U r very kind. : )
The last T-score I was able to have was 4 yrs ago...Just before my bilateral hip replacements. At that time my T-score was -2. My spine was just borderline osteopenia. I just had another DEXA last month and since they cannot scan my hips my forearm was scanned and my T-score was -3.3. I am just so worried bc I'll never know what is happening as far as BMD in my hips . I am so afraid to lose my mobility. I am very active and look forward to sports and being outside. I love nature and pretty much live a simple life. I like to be outdoors and enjoy animals. I'm so worried over this.
Kathleen, can I ask you what your thoughts on Reclast are? I am anemic and I read that could raise the chance of ONJ. I am so confused over the meds and what to do.
Can I ask where you live? I live in Texas but lived on Long Island until I was 60. I retired at 60 and moved to here. Sometimes I think if I were back in NY with the Dr's that know me that things might be different but who knows.
Thank you again for all your help. I really appreciate it. : )
@goseve insurance people know about their bottom line, they are not docs ! Speak up , havre your doc challenge them.
-
Like -
Helpful -
Hug
1 Reaction@goseve
Have you seen a good endocrinologist to do all the tests to check for any conditions or disease?
Another question why did you need bilateral hip replacements?
I gather that you have not had a TBS evaluation of your dexa score nor a REMS. Both of those would give us a better idea of your bone quality.
Put aside your fear of losing mobility, although I understand after the bilateral hip replacements why you are concerned. There are lots of things which you can do that will keep that fear from being a reality; the only thing you can do wrong is to do nothing. You are doing exactly what you need to do to protect yourself right now, researching and asking for input from others.
I am a strontium citrate user and a BHRT user. I am now in "normal" bone density and bone quality territory as per DEXA with TBS interpretation, no side effects, no fractures. So I really don't know much about Reclast.
I do know someone who does have knowledge though. His name is Michael, and he is an Inspire poster and a BHOF advocate. Here are links to his profile to contact him and to one of his posts. His profile link will have links to all of his posts and replies on Inspire.
New to osteoporosis meds post by Michael:
https://www.inspire.com/groups/bone-health-and-osteoporosis/discussion/new-to-osteoporosis-and-feeling-overwhelmed-this-training-will-help/
Link to contact Michael:
https://www.inspire.com/m/Michael_Lavacot/
Keep doing just what you are doing researching and talking with people. When you have enough knowledge you will be more confident and secure in any decision which you make.
If at any time you wish to learn about strontium citrate let me know, and I can provide that information. Strontium C may be begun and ended without any problems or side effects and works well with BHRT.
-
Like -
Helpful -
Hug
1 Reaction@goseve You write that after your hip replacement "... I'll never know what is happening as far as BMD in my hips"
But this article suggests that REMS tests (instead of DEXA) can measure it.
https://pmc.ncbi.nlm.nih.gov/articles/PMC12628398
If you don't know much about REMS tests you have lots of research ahead of you. There is more information and other links on other posts.
-
Like -
Helpful -
Hug
3 Reactions@kfhoz
what a great piece of research, Thank you!!
How to locate a REMS provider:
https://us.echolightmedical.com/find-a-provider/
@kathleen1314
Hi Kathleen. I needed bilateral hip replacements due to osteoarthritis. I also had bone spurs that were limiting my ability to move in certain ways and I had alot of pain due to the osteoarthritis.
I was interested in a REMS test and I called to schedule an appt. I asked if they could scan my hips and I was told that they couldn't due to the hip replacements and that they would only scan my back which is of no help because I do not have osteoporosis or osteopenia in my back. I asked if they would scan my forearm just to get an idea of my bone quality and they told me "they don't do that". That was very disappointing to hear.
I did have blood tests done by an endocrinologist and she said all my results looked good. I have not had a TBS evaluation.
I was interested in Storium Citrate but heard so many controversial opinions on it so I decided against it. I just started on a .50 transdermal estrogen patch in the hopes that it wil help my bone health. My endo dr. says that at my age it will not help but perhaps hold the bone that I have. I just don't know what to do.
The ortho surgeon says that my hip replacements are held in place by my bones and if the bones are weak then the replacements will not hold and there is not much that can be done at this point so I would be in a wheel chair. I am so afraid and just feel like it is a matter of time that this will happen to me. I don't have any children. I am married but I cannot expect my husband to care for me if I am in a wheelchair and I was denied long-I aterm care so this is so worrisome for me.
Thank you for all the info and the links you sent me. I am not very tech saavy so I am hoping that all my messages have gotten to you, apparently from your replies they have.
Thank you again Kathleen.
-
Like -
Helpful -
Hug
1 Reaction@kfhoz
HI Kathleen. I just called the REMS center to ask again about whether they can test my hips with hip replacements and they again told me no because I have total hip replacements in both. : (
@goseve
I called the Exholight Bone Scan in McKinney, Texas at 972-999-1765. I wish they could scan my hips but they insisted that they could not.
Thank you for all the info though. I cant tell you how helpful and kind you have been. : )
@goseve
Because this research is so new it looks like this might just be a difference in old conservative thinking and newer research and implementation of new research.
Seems that in the research context that Rems can be manually set to check the bone in the hip. Commercial rems is limited by the existing machines, existing software and lack of technician knowledge.
BUT.....
This is something that can be changed it just needs time.
BUT.....
For you.... here is what copilot suggested for your peace of mind:
IF her goal is:
“Is the bone holding my prosthesis strong enough?”
This is the most direct, precise, and surgeon‑trusted method available today.
CT‑Based Periprosthetic Bone Density Analysis (the gold standard)
What it does:
A CT scan can:
• Visualize the bone immediately surrounding the stem and cup
• Measure bone density in Hounsfield Units (HU)
• Detect early bone loss (osteolysis)
• Show whether the stem is well‑fixed or loosening
• Evaluate cortical thickness and trabecular quality
• Compare left vs right sides
• Track changes over time
Why it works
CT does not need to “see through” the metal — it uses metal‑artifact reduction algorithms that allow the radiologist to evaluate the bone around the implant.
What she would ask for
Surgeons order this all the time when they want to check implant stability.
-
Like -
Helpful -
Hug
1 Reaction