Forteo (teriparatide) followed by HRT: My Experience

Thank 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.

@mayblin
Hello, could you send me the link to the studies? I'm taking Tymlos 6 mo. Now and I started hrt 1 and a half months before I started the Tymlos. I'm hoping to just continue hrt to hold my gains. I'm using the .025 patch.
Thanks
Linda

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. : )

@goseve @wondering1 @gravity3 @lbrown742

Study 1 authored by Cosman/Lindsay
https://onlinelibrary.wiley.com/doi/10.1359/jbmr.2001.16.5.925
This was a small randomized trial with 52 patients. About half received 25mcg of teriparatide plus HRT daily for 3 years, while the other half continued HRT alone. After the 3 years, teriparatide was stopped but HRT was continued for an additional year. Results showed significant bone density gains with the combination, and those gains were maintained during the 1yr follow-up on HRT alone.

Study 2 authored by Ste-Marie
https://onlinelibrary.wiley.com/doi/10.1359/JBMR.051020
This was a larger randomized trial with 247 patients. About one half received 40mcg of teriparatide plus HRT for a median of about 14mo, while the other half received HRT plus placebo injections. The combination group showed significantly greater bone density gains than HRT alone. However, this study did not include a follow-up period after teriparatide was stopped, so we don't have info on whether or how those gains were maintained afterward.

I have a few thoughts and would love to hear opinions from everyone:

1. Neither study included a group taking teriparatide alone (without HRT), so we can't tell from these studies whether HRT + teriparatide was better than teriparatide by itself.

2a. The teriparatide doses in both studies (25mcg and 40mcg) were higher than the standard Forteo dose (20mcg). This means the results may not directly apply to a regimen using 20 mcg teriparatide because 2b 👇

2b. Clinical studies had shown that 40mcg teriparatide produces significantly larger bmd gains than the 20mcg dose

3. Neither study specified dose or form of estrogen but likely used what was considered a "standard" dose at the time (such as oral conjugated estrogen - Premarin 0.625 mg or equivalent)

4. Only the smaller study by Cosman/Lidsey had HRT-alone as follow-up after teriparatide. While the results were encouraging, the small size and short follow-up period make it hard to draw firm long-term conclusions.

Because of those differences in dosing and study design, we can't directly assume that goseve’s specific combination (20mcg teriparatide in Forteo + 0.075 mg estradiol patch) will produce the same results. That said, the Cosman/Lidsey study does suggest that HRT provides some level of bone protection during and after anabolic therapy.

I used Cosman’s paper as the basis for my discussion with my endo. Looking ahead, my dream scenario would be to stay on HRT continuously and simply add Forteo (or Tymlos) whenever I need a little BMD boost. Whether that would actually work is another question entirely - but a person is allowed to dream, right? 😊

@goseve @wondering1 @gravity3 @lbrown742

Study 1 authored by Cosman/Lindsay
https://onlinelibrary.wiley.com/doi/10.1359/jbmr.2001.16.5.925
This was a small randomized trial with 52 patients. About half received 25mcg of teriparatide plus HRT daily for 3 years, while the other half continued HRT alone. After the 3 years, teriparatide was stopped but HRT was continued for an additional year. Results showed significant bone density gains with the combination, and those gains were maintained during the 1yr follow-up on HRT alone.

Study 2 authored by Ste-Marie
https://onlinelibrary.wiley.com/doi/10.1359/JBMR.051020
This was a larger randomized trial with 247 patients. About one half received 40mcg of teriparatide plus HRT for a median of about 14mo, while the other half received HRT plus placebo injections. The combination group showed significantly greater bone density gains than HRT alone. However, this study did not include a follow-up period after teriparatide was stopped, so we don't have info on whether or how those gains were maintained afterward.

I have a few thoughts and would love to hear opinions from everyone:

1. Neither study included a group taking teriparatide alone (without HRT), so we can't tell from these studies whether HRT + teriparatide was better than teriparatide by itself.

2a. The teriparatide doses in both studies (25mcg and 40mcg) were higher than the standard Forteo dose (20mcg). This means the results may not directly apply to a regimen using 20 mcg teriparatide because 2b 👇

2b. Clinical studies had shown that 40mcg teriparatide produces significantly larger bmd gains than the 20mcg dose

3. Neither study specified dose or form of estrogen but likely used what was considered a "standard" dose at the time (such as oral conjugated estrogen - Premarin 0.625 mg or equivalent)

4. Only the smaller study by Cosman/Lidsey had HRT-alone as follow-up after teriparatide. While the results were encouraging, the small size and short follow-up period make it hard to draw firm long-term conclusions.

Because of those differences in dosing and study design, we can't directly assume that goseve’s specific combination (20mcg teriparatide in Forteo + 0.075 mg estradiol patch) will produce the same results. That said, the Cosman/Lidsey study does suggest that HRT provides some level of bone protection during and after anabolic therapy.

I used Cosman’s paper as the basis for my discussion with my endo. Looking ahead, my dream scenario would be to stay on HRT continuously and simply add Forteo (or Tymlos) whenever I need a little BMD boost. Whether that would actually work is another question entirely - but a person is allowed to dream, right? 😊

@lbrown742

Do you also take progesterone and testosterone? I am at .0375 with 200 mg progesterone. I also have testosterone cream and vaginal estradiol cream.

@goseve @wondering1 @gravity3 @lbrown742

Study 1 authored by Cosman/Lindsay
https://onlinelibrary.wiley.com/doi/10.1359/jbmr.2001.16.5.925
This was a small randomized trial with 52 patients. About half received 25mcg of teriparatide plus HRT daily for 3 years, while the other half continued HRT alone. After the 3 years, teriparatide was stopped but HRT was continued for an additional year. Results showed significant bone density gains with the combination, and those gains were maintained during the 1yr follow-up on HRT alone.

Study 2 authored by Ste-Marie
https://onlinelibrary.wiley.com/doi/10.1359/JBMR.051020
This was a larger randomized trial with 247 patients. About one half received 40mcg of teriparatide plus HRT for a median of about 14mo, while the other half received HRT plus placebo injections. The combination group showed significantly greater bone density gains than HRT alone. However, this study did not include a follow-up period after teriparatide was stopped, so we don't have info on whether or how those gains were maintained afterward.

I have a few thoughts and would love to hear opinions from everyone:

1. Neither study included a group taking teriparatide alone (without HRT), so we can't tell from these studies whether HRT + teriparatide was better than teriparatide by itself.

2a. The teriparatide doses in both studies (25mcg and 40mcg) were higher than the standard Forteo dose (20mcg). This means the results may not directly apply to a regimen using 20 mcg teriparatide because 2b 👇

2b. Clinical studies had shown that 40mcg teriparatide produces significantly larger bmd gains than the 20mcg dose

3. Neither study specified dose or form of estrogen but likely used what was considered a "standard" dose at the time (such as oral conjugated estrogen - Premarin 0.625 mg or equivalent)

4. Only the smaller study by Cosman/Lidsey had HRT-alone as follow-up after teriparatide. While the results were encouraging, the small size and short follow-up period make it hard to draw firm long-term conclusions.

Because of those differences in dosing and study design, we can't directly assume that goseve’s specific combination (20mcg teriparatide in Forteo + 0.075 mg estradiol patch) will produce the same results. That said, the Cosman/Lidsey study does suggest that HRT provides some level of bone protection during and after anabolic therapy.

I used Cosman’s paper as the basis for my discussion with my endo. Looking ahead, my dream scenario would be to stay on HRT continuously and simply add Forteo (or Tymlos) whenever I need a little BMD boost. Whether that would actually work is another question entirely - but a person is allowed to dream, right? 😊

@gravity3
I take 100 mg progesterone. My endo is against testosterone.

@goseve @wondering1 @gravity3 @lbrown742

Study 1 authored by Cosman/Lindsay
https://onlinelibrary.wiley.com/doi/10.1359/jbmr.2001.16.5.925
This was a small randomized trial with 52 patients. About half received 25mcg of teriparatide plus HRT daily for 3 years, while the other half continued HRT alone. After the 3 years, teriparatide was stopped but HRT was continued for an additional year. Results showed significant bone density gains with the combination, and those gains were maintained during the 1yr follow-up on HRT alone.

Study 2 authored by Ste-Marie
https://onlinelibrary.wiley.com/doi/10.1359/JBMR.051020
This was a larger randomized trial with 247 patients. About one half received 40mcg of teriparatide plus HRT for a median of about 14mo, while the other half received HRT plus placebo injections. The combination group showed significantly greater bone density gains than HRT alone. However, this study did not include a follow-up period after teriparatide was stopped, so we don't have info on whether or how those gains were maintained afterward.

I have a few thoughts and would love to hear opinions from everyone:

1. Neither study included a group taking teriparatide alone (without HRT), so we can't tell from these studies whether HRT + teriparatide was better than teriparatide by itself.

2a. The teriparatide doses in both studies (25mcg and 40mcg) were higher than the standard Forteo dose (20mcg). This means the results may not directly apply to a regimen using 20 mcg teriparatide because 2b 👇

2b. Clinical studies had shown that 40mcg teriparatide produces significantly larger bmd gains than the 20mcg dose

3. Neither study specified dose or form of estrogen but likely used what was considered a "standard" dose at the time (such as oral conjugated estrogen - Premarin 0.625 mg or equivalent)

4. Only the smaller study by Cosman/Lidsey had HRT-alone as follow-up after teriparatide. While the results were encouraging, the small size and short follow-up period make it hard to draw firm long-term conclusions.

Because of those differences in dosing and study design, we can't directly assume that goseve’s specific combination (20mcg teriparatide in Forteo + 0.075 mg estradiol patch) will produce the same results. That said, the Cosman/Lidsey study does suggest that HRT provides some level of bone protection during and after anabolic therapy.

I used Cosman’s paper as the basis for my discussion with my endo. Looking ahead, my dream scenario would be to stay on HRT continuously and simply add Forteo (or Tymlos) whenever I need a little BMD boost. Whether that would actually work is another question entirely - but a person is allowed to dream, right? 😊

@lbrown742

We can all learn from what our physicians share. Do you mind telling me why he/she is against testosterone? Is it particular to you and your medical history or is it a general objection to it for women. I am not asking for any information about your history. I feel as though we are trying to fill in the blanks that exist so that women get exactly the individual treatment that is appropriate for us. Thanks