Hi @mayblin - Thanks for the information on maintaining BMD with HRT after Forteo. That is really good news. Perhaps that will hold with Tymlos as well.

As for HRT + teriparatide being better than teriparatide alone, I actually heard that during a training from an HRT expert, I just can't remember which training. And the study I thought showed that, only shows teriparatide + HRT is better than HRT alone. After doing some looking, you're right, there aren't any direct trials showing this, but I did find meta analysis of studies showing HRT + teriparatide gave better results than teriparatide alone https://onlinelibrary.wiley.com/doi/10.1111/j.1742-1241.2011.02837.x . While I have not purchased the study, here is a CoPilot summary:

"The Spine Benefit: The combination of teriparatide and HRT yields substantial lumbar spine BMD increases depending on the trial and baseline patient characteristics, comparing favorably with standard teriparatide-only averages.
The Hip Benefit: While teriparatide alone has a more gradual impact on cortical bone like the hip, adding it to an antiresorptive like HRT supports total hip and femoral neck density. "

Lastly, when I stated “if you are going to do HRT, you might want to start now”, I was not thinking about BMD retention after stopping, I was thinking about the BMD benefit of adding both together and squeaking out a bit more BMD increase before completing Tymlos.