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Forteo (teriparatide) followed by HRT: My Experience
Osteoporosis & Bone Health | Last Active: 10 hours ago | Replies (269)Comment receiving replies
@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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Thanks so much @mayblin for your response. Unfortunately, my doctors don't seem to know as much as I do about this. I see my PCP next week and will get her opinion. Maybe I could get an appointment with the PA who suggested estrogen in the first place, but wouldn't prescribe it. The estrogen is prescribed by a functional physician, so I could ask her. My endocrinologists will just tell me to take Evenity, Prolia or Reclast, but I will ask the one who has mychart. From what you wrote, it is good that my CTX went down not up.
I am considering taking more calcium, since my blood level went down to 91 from 94. Also, I am considering taking Strontium again. My first bone marker results on 12/23 were P1NP 78 and CTX 519. At that time, I had been on 20 mcg, 2 clicks, for a month and 300 mg of Strontium citrate for a year. That was a better ratio than what I have now, 38 and 371.
I also wonder if the progesterone cream is lowering the influence of estrogen. If I stopped using the cream, would that lower the CTX? It does help me sleep.