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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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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?
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1 Reaction@mkoch
May I ask how old u r as I’m 78 and my Dr said I’m too old for hormones
@psmnonna
Hi I’m 78 and told too old for BHRT. May I ask your age when started? I was also told since I was never on HRT I wasn’t a candidate for BHRT,
@fili123
I am 68. Never had any sort of hrt in the past. The bioidentical hormone estradiol patch is safe as well as the vaginal estradiol cream. Age doesn't matter for those. Of course you get the most benefit starting at a younger age, but most of us didn't know that 20 yrs ago, unfortunately.
Have a discussion of all risk factors with your Dr. Also look here for more posts on hrt and age. Lots of people here who are in their 70s use hrt therapy.
Good luck!!
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3 Reactions@fili123: I am 74. I was taken off my .025 estrogen patch 7 years ago, at age 66 & 1/2, as I was diagnosed with breast cancer. Even though there are no definitive studies to prove it, I won't go on Forteo because it promotes bone growth, and I worry that mechanism could somehow also promote any dormant cancer cells in my body to grow as well. But I was on it years ago in my 50s, never had a side effect, and my results were stellar. I am now on Prolia which slows bone breakdown.
@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.
Thanks @kathleen1314. I like what you found out, and I will try it.
@mayblin It does seem that quitting hormone replacement at least influenced my rapid decline. I would not use them again because of that.
@broken13
Why is that? Why would you not use hormone replacement again since you feel that stopping the HRT seemed to lead to a rapid decline in your bone health and was possibly tied to your fractures?
@broken13
I'm not sure I understand why you do not want to return to bhrt. Can you clarify?
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