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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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@singingbones, yes, bone markers - especially CTX -have been the primary lab used during my transition as an indicator of therapeutic response. My doctors (endo or obgyn) have generally not been keen on checking estradiol blood levels.
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1 Reaction@drsuefowler, i’ve been on the 25mcg patch and haven’t needed a higher dose, as my CTX has remained consistently low, in the low 100s. The DXA results from my first year on HRT are shown in the image attached to the original post, although those results were somewhat confounded by my use of 3 leftover Forteo pens during that period (month 7-11 on HRT). We’ll see whether the second year on HRT alone, with this level of bone turnover suppression, translates into BMD preservation at my next DXA scan in a few months.
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1 Reaction@suzij
When you've been on Prolia (denosumab) for several years and if you are considering transitioning off it, a carefully planned exit strategy with your doctor's guidance is essential. Forteo (teriparatide) is generally not advised as the next step after Prolia, based on the DATA-Switch clinical trial. Dr. Ben Leder, the lead investigator of that study, explains why in this talk — see around 30:15 of this video:
I thought this might be helpful as you weigh your options.
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7 ReactionsThanks @mayblin
@mayblin
This was very helpful. Thank you! Exactly the information I have been looking for, and Dr. Leder's experience tracking osteoarthritis supplements and treatments is quite useful. Interesting take on general practitioners who prescribe Prolia as the first treatment rather than referring patients to an endocrinologist. This is a new journey for me, perhaps a shock facing the complexities of figuring out what works since I've not had major health issues, and experiencing the insurance-patient-physician vortex that older adults face when they are simply trying to enjoy life and health.
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2 Reactions@mayblin
I read ur post and was happy to hear that Forteo is working for u. I have severe osteoporosis and have bilateral hip replacements so my ortho surgeon told me that I must do something for my osteoporosis. I was prescribed Forteo but have not started taking it yet. I was told I will need Fosomax or Reclast after Forteo. I am afraid of bisphosphonates bc I have alot of dental problems and I have many teeth that are capped but might need dental implants in a few yrs. I am on a .075 transdermal estrogen patch and was wondering if that could hold my gains from the Forteo. From reading ur post it sounds like the HRT is holding ur gains. Can I ask u if u think a transdermal estrogen patch could hold my gains? Thank u for reading this and for any suggestions. I wish you healthy bones! : )
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2 ReactionsThank you, @goseve.
There are two small clinical studies that examined the use of teriparatide (the active ingredient in Forteo) in combination with HRT. In one of the studies, participants continued HRT alone for one year after stopping teriparatide, and their bone density remained stable. It's worth noting though, that the treatment dosing regimens in those studies differed from yours - you'll be using 20 mcg of teriparatide along with a 0.075 mg estradiol patch - so the findings cannot be directly applied to your situation. I'd be happy to share links to the studies if you're interested in reading them.
Given your bilateral hip replacements, your managing physician will likely need to consider not only your overall bone strength but also the long-term stability of the bone surrounding the implants.
If you decide to rely on HRT alone for skeletal protection after Forteo, I think it’s good idea to discuss this plan with your doctors early on; whether the approach is appropriate for your situation, how best to monitor the maintenance of your Forteo gains (such as with DXA scans and possibly bone turnover markers), and what backup options might be available if additional treatment becomes necessary.
Good luck on your journey, and please keep us posted on your progress.
Thank you so much mayblin! The biggest problem I have is that I have osteoporosis in my hips. and the DEXA cannot measure my hips due to the hip replacements. The last DEXA was 7 yrs ago before my hip replacements and I was at -2.0 so by now I am sure I am much worse. My back is fine but my wrist was -3.3 on my last DEXA. I'd love you to send me more info if you can. I am not very tech savvy but will do my best to access anything that you send. Thank you again for sharing all your knowledge. : )