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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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@smodesitt
Maybe your endocrinologist has outdated information on bhrt? I remember asking my endocrinologist for bhrt and he said "I don't do hormones. " I thought it was very odd but I suspect that some of the big medical groups may still be under the influence of the flawed women's health initiative study.
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1 Reaction@smodesitt
I overlapped Forteo and HRT for about a week at the end of my Forteo treatment - not for any particular reason, and certainly not based on evidence. It ended up working out fine for me. From what I’ve read and from my own experience, it takes about 6 months for HRT to achieve its maximal suppression of bone resorption.
Now that your cardiologist has cleared you, would your OB-GYN (or perhaps another OB-GYN) be willing to prescribe HRT?
Since you’ve had a hysterectomy, you could use estrogen-only HRT (double-check with your physician), and it generally is considered to have a more favorable risk profile than combined estrogen-progestogen therapy. Most OB-GYNs now prefer transdermal estradiol patches - they are bioidentical, FDA-approved, easy to adjust (dose) and typically covered by insurance. If you’re interested, you can look up discussions on preferred HRT formulations, for example, Dr. Jen Gunter has an excellent evidence-based series on MHT on her Substack, including discussions of different formulations and why transdermal estradiol is often preferred.
If you’re also considering testosterone, I’d make sure your cardiologist is comfortable with that as well.
For reference, I pay $20 for a 3mo supply of estradiol patches and a $30 copay for my yearly OB-GYN visit with insurance coverage. My doctors monitor my bone turnover markers (BTMs), which I find helpful for tracking how my treatment is working. If needed, blood estradiol level can be done and covered.
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2 Reactions@mayblin
Thank you for that information!
@gravity3
I think you may be right. Mine wasn't too keen on it. But I have my checkup next month and am going to bring it up again. If she doesn't have a medical reason for not starting, I may do it anyway.
@smodesitt Is there a particular reason that you prefer compounded vs patch?
@tesslu2 it makes you wonder why it would cause heart problems or strokes
My ob/gyn's wife is a functional medicine doctor. She prescribes pellets that are inserted under the skin. Last 3 months. However, they aren't covered by insurance. I'm going to get more information on it when I go in for my consult. I already finished bloodwork as the first step. Although I'm low in testosterone, my cardiologist doesn't recommend it, since I have genetic heart disease.
So interesting. My neurologist wants me to add an anabolic to the mix but when I research (for Australia mindset) they cap it off with a bisphosphonate I wasn’t that keen. HRT is my go to. So HRT is working to cap it off in your experience still?
@vmcgrantham
What are the reasons he is suggesting reclast and Prolia rather than an anabolic first?
@dezzie
Who are you replying to?