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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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@goseve
Consider doing some more research on strontium citrate.
In some TBS research strontium was one of the top osteoporosis drugs with Forteo, prolia. (see chart attached below and link in below explanation)
strontium user stories:
Indeed, in this analysis published by JBMR, a comparison of osteoporosis drugs found that Strontium was in the top comparison of DEXA and Microarchitecture with Prolia and Forteo. found on Page 7 panoramaortho.com (see attached chart below)
https://www.inspire.com/m/Kathleen1314/journal/d69831-strontium-users-stories-3-alternative-to-pharma-meds/
Strontium compilation of posts and research:
https://www.inspire.com/groups/bone-health-and-osteoporosis/discussion/dd823b-strontium-a-compilation-of-research-and-information/
2020 review of strontium latest insights:
https://www.inspire.com/groups/bone-health-and-osteoporosis/discussion/2020-a-review-of-latest-insights-into-the-mechanism-of-action-by-strontium-/
The review (science direct link, in above link) does seem to suggest that strontium works with hydration levels and in areas that form "sacrificial bond formation" in ways that correlate to reduced fracture risk. In other words, strontium seems to work mainly because it changes the physiochemical relationship in bone to allow bone the ability to absorb shock and dissipate instead of break....give instead of break. Section 4.2
Indeed the concerns frequently raised by posters on Inspire about dxa skews and calcium replacement may be ignoring totally how strontium actually seems to work. Strontium seems to form a valuable effect in especially new, hydrogenated bone. An effect where it fills areas not filled by calcium and may replace some calcium, but in doing so allows for sacrificial bonds to be formed that absorb shock and allow for a bone that breaks less easily. Something about strontium allows for a less fracture prone bone. So this naturally occurring mineral that is in seawater, seafood, organic vegetables and ground water seems to play a natural role in keeping our bone fracture free. Section 4.2
Bone Biopsy photos show the effect of strontium see the attached photo with the link to the research.
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1 ReactionOh Kathleen, THANK YOU! I am going to show your post to my dr. I am just hoping and praying that she will order a CT so that I can chk my BMD of my hips. I have an appt with my primary dr. next Thursday so I will let you know.
Kathleen, I am not tech savvy so I dont know if I'll be able to find you again on this site. Would you be willing to private message me your email so I can email you and let you know how I made out. I'm thinking that if neither of those two suggestions are good for you, you can send me another post thru here next Friday if you want to know how I made out. You have helped me beyond words and I appreciate it so very much. : )
Hi @goseve,
You will notice I removed your email from your post. Mayo Clinic Connect is a public website and we want our members to protect themselves from unwanted solicitations or a breach of private information. I updated your post to request @kathleen1314 to share their email via the private message function that will only be between the two of you. You can access your private messages by scrolling to the top right corner and click on the envelope symbol.
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3 Reactions@kathleen1314
This is so informative and helpful. I have gone to my ortho surgeon on numerous occasions asking if there were any way that he could see the condition of my bones because I am so worried about the bones not being able to hold the hip implants. I have gone at least 4 times since my surgery and have told him that I am very concerned and if there were any type of test that could be done to determine the condition of my bones. I was always told no and to just take meds. It's just incredible how some doctors really don't care and do not want to be bothered. Now, I have to see if this surgeon will write me a prescription for a CT of my hips.
I don't think I am a candidate for bisphosphonates because I have anemia and am immunocompromised. I've read that there is a bigger risk of ONJ having anemia and taking bisphosphonates and being immunocompromised is a risk factor for Prolia because you are more prone to infections and with the hip replacements that is a big problem.
I would like to take Forteo bc the risks are less and I could maintain the bone benefits with a transdermal estrogen patch. If I take Prolia, I would have to relay off with Fosamax and I am afraid to take Fosamax with my health issues. I have to constantly be careful that I do not get an infection bc the ortho surgeon said my body is different now in that I have a prosthetic implant and it doesn't respond well to antibiotics and if I do get an infection, it's a big problem and I could need surgery and they would take the implant out and sterilize it before reinserting it back in and this could take several weeks. I have too many health issues!
Thank you Kathleen and I hope I didn't bore you with all my problems.
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1 ReactionOh Kathleen, THANK YOU! I am going to show your post to my dr. I am just hoping and praying that she will order a CT so that I can chk my BMD of my hips. I have an appt with my primary dr. next Thursday so I will let you know.
Kathleen, I am not tech savvy so I dont know if I'll be able to find you again on this site. Would you be willing to give me your email so I can email you and let you know how I made out or if you'd prefer, you can private message me. I'm thinking that if neither of those two suggestions are good for you, you can send me another post thru here next Friday if you want to know how I made out. You have helped me beyond words and I appreciate it so very much. : )
@goseve
There may be a reason why your doctor has not suggested the CT scan; everything has minuses and pluses and is tied to you personally. So I would just ask if this is possible and appropriate for your condition.
Research the pharma drugs, Talk with Michael and research strontium citrate. The links which I gave you should give you what you need.
Then work with your doctor; they can be your best advocates.
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1 Reaction@goseve
we should be able to find one another easily.
I look forward to hearing what you find out. Your doctor may have some insights and they know your case backwards and forwards.
Thank you Kathleen! 😊
@tpinheiro29 Thank you so much for that information!!! I had not heard that before and specifically asked the endocrinologist about autoimmune implications. I complete teriparatide in April and am thinking to just go back on Raloxifene for maintenance. Seems the least side effects and worked for 10 years last time. I would be willing to do Forteo/teriparatide again if I need another booster down the road.
@broken13
I like your Forteo --> raloxifene sequence, and repeating it whenever bone building is needed again, especially since both Forteo and raloxifene have worked well for you. Thanks for sharing.
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3 Reactions