@mdg224
Congratulations on the great improvement! Did you use HRT alongside Tymlos? Could you clarify the time points for your CTX values of 600 and 175, and which drug(s) were involved at each?

My progress from Forteo to 1yr on HRT is shown in the table:
https://connect.mayoclinic.org/discussion/forteo-teriparatide-followed-by-hrt-my-experience/
I had average gains during Forteo and substantial gains during the first year on HRT. However, my P1NP was still elevated when coming off Forteo, and I also used 3 leftover Forteo pens during months 7–11 on HRT, so multiple factors contributed to those gains. Year two on HRT should provide a clearer picture.

Yes, I monitor BTMs periodically along with yearly DXA scans. Because there are no well-established protocols to follow, I prefer knowing my CTX level before each DXA and am also curious whether any correlation exists between CTX and BMD stability. So far, my CTX has remained consistently below 120 during the second year of HRT, and I am due for my next scan in a few weeks. We’ll see what the DXA shows - I’ll share the results in my ‘Forteo followed by HRT’ thread

I’ve talked with my endo about the possibility of using Forteo again if my T-scores/BMD, or FRAX deteriorate significantly in the future. Estrogen could serve as a useful antiresorptive maintenance or transition therapy; the practical details would of course need to be worked out carefully.

I believe the major shift in medical practice after the WHI, and the resulting lack of clinical studies on estrogen for osteoporosis, have significantly limited our understanding of how to use it most effectively. Sharing information and experiences among us is therefore especially valuable.