Anyone use HRT as their immediate follow-up to Tymlos or Forteo?

Annie208–very good question..I’m in the research phase and welcome these questions and hope some great discussion and expertise will light the way…wishing you the best !

In transitioning from Tymlos or Forteo to HRT or Bisphosphonates you are basically going from builders to keepers in terms of bone health. If you transition to BHRT and strontium citrate you are going to a keeper and a reinforcer with strontium use.
Research is limited on HRT use instead of Tymlos or Forteo:
The best direct research seems to be using HRT during Forteo treatment. Found with a google search:
"Some studies suggest that starting HRT during anabolic treatment (combination therapy) rather than just after can result in significantly greater BMD increases (e.g., 14.1% in the spine) compared to HRT alone. "
https://pubmed.ncbi.nlm.nih.gov/16418784/
Several research articles and Menopause Societies list HRT as an alternative to bisphosphonates and even to other osteoporosis drugs.
https://theros.org.uk/information-and-support/osteoporosis/treatment/hormone-replacement-therapy/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10009319/
Here is one Mayo discussion of use of HRT after Forteo:
https://connect.mayoclinic.org/discussion/forteo-teriparatide-followed-by-hrt-my-experience/
One of the many advantages of HRT and one not always discussed is:
No Long-Term Retention: Unlike bisphosphonates, which can stay in the bone for over a decade, HRT has a shorter half-life, which may be preferred by patients concerned about long-term drug accumulation.

For what it's worth, I'm on the Evenity drug for a few more months (no prior med/no fractures/72 yrs). I have been on HRT for several yrs at a minimal dose for vaginal dryness--apparently not enough to significantly impact bone integrity (severe OP). I will be seeing a hormone specialist soon to evaluate strengths of hormones in light of OP. I've read several articles & medical publications (many that kathleen1314 has recommended) & testimonies that report bone density improvement with HRT and/or strontium citrate alone. When the Evenity course is completed, I plan to add strontium citrate to my current regime of supplements & hormones.

I am 67 and never took hrt. My endocrinologist agreed to start me on hrt. About 6 weeks weeks later I started on Tymlos. I'm almost 3 months in and had a 297% increase in my P1NP. My hope is to continue on hrt on completion of Tymlos and see how I do. I did find a study on women ages 58 - 80 on hrt, that showed they all maintained bone density after 4 years. I would prefer to skip reclast if at all possible. I hope maybe there will be more info available in a year from now.

I am 70. I had a hysterectomy with partial oophorectomy at age 34. I was on Premarin oral tb up to age 50 when clinical research data showed cardiovascular&blood clots and oncological risks. Ten years ago, I had a T11 vertebral fracture with 10% compression and a few rib fractures. That time, I received Reclas IV infusion once and was never followed up on. I am recovering from the same T11 vertebral fracture, but this time with 20-25% compression. I have several risk factors, such as hypertension and plaque on my coronary arteries, and I am not sure if I can be on anabolics. I am exploring if I am a candidate for HRT and learning more from other women's experiences. Thank you for sharing your experience!

@annie208
Yes to all. I finished my 2 years of Tymlos at the end of Feb 2026. But have been on hrt since September 2025. (.025 mg estradiol patch biweekly, 100mg progesterone daily) So there was a 5 month overlap where I was on both Tymlos and hrt. I'd been pushing for hrt for 2 yrs but was told no by everyone until I found a gyn who was open. My 2 yr ending lumbar t scores gained more than my first years score. My endo did comment that the hrt most likely helped boost my year two bone improvements.
( 1st year -3.6 to -3.1, 2nd year -3.1 to-2.5) Oddly when I told her I had started hrt 5 months prior she was now totally OK with it. I'm pretty sure it's because she finally caught up with the current research. I was told to pick either reclast or alendronate as my follow up. I politely declined and am continuing on hrt alone as my follow up plan. Along with making sure I get daily protein, lift weights 3-4 times a week using the onero suggested lifts and jumps. I'm working on physiologic optimization of hormones and that will be my next discussion with my gyn. Currently waiting for that appt. There's a lot of wait time to see the different specialists which is what it is. I keep plodding along. Next dexa is Feb 2027. Hoping not to crash and burn all my gains which is a real possibility, but I'm (maybe blindly?) optimistic ✌️
Good luck and cheers to us all!
Nonna

@psmnonna This is very interesting. I’m going to finish my Tymlos in July and my Rheumatologist has been pushing Prolia which I refuse to go on, I’m just not comfortable with it. I’ve made excellent gains so far with Tymlos but am really not thrilled to go on another drug. I’m 66 and have no other health issues and do regular strength training. My Dr. never suggested HRT to me I’m wondering if I should see an Endocrinologist for a 2nd opinion. I’m wondering if HRT therapy might be an option for me when I stop Tymlos to keep my gains. Has anyone else gone to HRT alone after Tymlos?

@margaretk @annie208
I had transitioned to HRT right after Forteo with no other meds, read my story here:
https://connect.mayoclinic.org/discussion/forteo-teriparatide-followed-by-hrt-my-experience/

@margaretk
It is certainly worth a discussion with your endo or a gynecologist. I am not a fan of Prolia or any of the bisphosphonates and I'm going to resist them as long as I can.

@psmnonna
Great job! It is nice progress to get -2.5.
Can you please share more information about what you mentioned, "lifts and jumps"? Is it under an experienced osteoporosis trainer? Thank you!