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← Return to Forteo (teriparatide) followed by HRT: My Experience
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Forteo (teriparatide) followed by HRT: My Experience
Osteoporosis & Bone Health | Last Active: 16 hours ago | Replies (268)Comment receiving replies
I just got back P1NP and CTX results. I was on Forteo for 6 months and a half dose of Tymlos for 17 months. I have been on 14mcg Menostar for 6 months. I quit taking Tymlos and started progesterone cream a month ago, because of abdominal pain. I have a history of endometriosis and thought that the progesterone might help with pain if it was from that. An ultrasound of my pelvis showed a fluid filled Fallopian tube and an abdominal ultrasound showed hydroureteronephrosis. A second ultrasound of the kidneys no longer showed that. The abdominal pain is now gone. I am sensitive to medications and prefer not to take Reclast or Prolia.
The best ratio I have had was on 10/1/25 when I had been on both 40 mcg Tymlos and 6 months of Menostar. P1NP was 147 and CTX was 654. There has been a big change without the Tymlos and with the added progesterone cream. P1NP is now 38 and CTX is 371. I am pleased that CTX is lower, but very concerned that P1NP is so low. Should I be concerned enough to increase estrogen, decrease progesterone or start taking Tymlos again? I still have Tymlos in my refrigerator. My endocrinologist doesn't want to see me until May, and my gynecologist can't get me in until April.
What is the ratio of P1NP to CTX supposed to be when trying to hold in gains?
Replies to "I just got back P1NP and CTX results. I was on Forteo for 6 months and..."
@drsuefowler, here are my thoughts: your current bone marker levels are primarily determined by your estrogen (an antiresorptive), since you’ve stopped Tymlos for a month now. If you adjust estrogen dose, your CTX (resorption) will move accordingly. There isn't a way to 'fine-tune' the CTX P1NP ratio because of the coupling effect.
Adding or restarting Tymlos at this point is an unknown, as most of the anabolic effects of a PTH analog diminish after 18–24 months for the majority. If you do decide to reintroduce Tymlos, I’d love to see how your bone markers change, so please keep me in the loop.
I don’t believe there is a consensus on a magic 'ratio' for holding gains. However, it does appear most experts agree that the key is ensuring resorption (CTX) doesn’t start to accelerate once an anabolic treatment ends. Given that you've transitioned to HRT, have your doctor(s) mentioned any specific target levels they want to see for your markers?
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@drsuefowler
Sue, consider running your numbers thru AI copilot, if you feel comfortable with that. I put in what you posted and the AI felt based on NIH information that:
The shift from her previous markers (P1NP 147, CTX 654) to her current ones (P1NP 38, CTX 371) reveals a significant transition in her bone metabolism. This typically occurs when moving from an anabolic (building) phase to a maintenance phase.
But you will be able to give copilot more information and ask questions of it about what you are taking and how it is affecting you.
Then you could run this past your doctors.