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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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@lbrown742
Thanks so much. I appreciate you sharing this.
@goseve you and I share many of the same issues. I had bilateral hip replacements in 2017 so my hips cannot be measured with a DEXA scan. My spine has suffered a lot of disc damage and degenerative damage over the years and there again the DEXA scan is not reliable. My Radius wrist measurement with DEXA was -3.2. I am on Tymlos now for nine months but not taking the standard dose and instead taking only 70 MCG. I would very much like to start taking HRT but I have been post menopause for 25 years and at age 77. Most doctors seem loath to prescribe HRT I am interested in learning what you will be doing for treatment.
@willowmena
You might explore a functional medicine practice. They helped me start bhrt at 77. I had early menopause at 38.
I wish you well.
To: Forteo (teriparatide) followed by HRT: My Experience
Posted by mayblin @mayblin, Sep 29, 2025
Excellent info! Thank you for sharing about FORTEO! Especially with details of your age, before and after scan numbers among other excellent details. Most interesting using HRT after Forteo. I wish you the very best on the bone loss/bone build journey we share.
I am 75 years old. My Spine is my main concern because I experienced an “age related compression fracture”, after a trip stumble going up the stairs, falling on my belly and chest. And I am diagnosed with osteoporosis in my spine.
My PCP suggested I go on to oral medication of Alendronate or once a year IV Reclast. I needed more information and I requested an Endocrinology consult!!
I had to wait four months for my appointment, which I accomplished last Monday, June 15, 2026. The Endocrinologist suggested anabolic Forteo self injections for up to two years. Followed by trying to maintain that new bone that we hopefully would have built, by going on antiresorptive therapy of Reclast or Alendronate.
The Endo specialist ordered a 24 hour urine test, one fasting comprehensive metabolism panel, and 11 other non-fasting tests to hopefully see if or how I was losing calcium. I will get the results of all the lab tests and the 24 hour urine test this week.
You are correct not many people speak about the best anabolic therapy of FORTEO or TYMLOS. They are the big guns of bone building, and with your results apparently they served you well. Thank you very much for sharing your story.
Nan
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2 Reactions@countryliving, sorry to hear about your fracture; I hope you've recovered well! It sounds like you're receiving excellent care from your endocrinologist, with a thorough evaluation for secondary causes of bone loss and an anabolic as first-line treatment. Please keep us posted on your progress. Wishing you the very best on your journey to stronger bones.
@gravity3
There is a good article on the topic: https://mcpress.mayoclinic.org/women-health/testosterone-not-just-for-men/
My cardiologist advised me to stay away from testosterone because I have known coronary artery disease (CAC score 38). Her concern was that the long-term cardiovascular safety of testosterone in women remains uncertain, so she felt it was prudent to avoid additional exposure given my underlying risk factors. That said, I’m quite happy with my current regimen of transdermal estradiol and micronized progesterone. I’ve experienced minimal side effects, better sleep, and satisfactory suppression of bone turnover markers, which was my primary goal.
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2 Reactions@mayblin
Thank you!
And I will keep in touch.