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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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Thank you.
This HRT question in post menopausal women seems like a hot topic - especially since the old HRT harm studies from decades ago have been debunked.
It’s a shame women didn’t have access to HRT until it was too late ( bone already lost) now we are scrambling to get some bone back in our 60’s .
I’m 65.
I started fosomax weekly pill today but I’m meeting with gyno doctor tomorrow to discuss either adding HRT to it or not doing fosomax and just doing HRT . My bone dr says if I do both she will lower the dose of the fosomax to 35mg.
Neither dr seems sure of what yo do with me . I just dread being on bone drugs the rest of my life .
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1 Reaction@mayblin
May I ask how old you are. ? I’m 70
@ipg
78...I've been on bone meds for quite a while. Started bhrt last year
@2024tymloshelp Please let us know what your doctor says. Is your bone doctor an endocrinologist?
@mayblin
I was just following up to see if you did have your follow up dexa after switching to the HRT alone and how your gains held up (only if you wish to share)? I hope well! Thanks!
Doctor is a rheumatologist
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1 ReactionShe tested me for possible causes of my poor bone density- no underlying cause other than menopausal estrogen loss
Since my spine density improved from Tymlos (5% ) which isn’t great but at least it did something , I have to move on to something else and protect what I’ve got .
@2024tymloshelp
There is some published research looking at combining a bisphosphonate with hormone therapy. One example
https://pubmed.ncbi.nlm.nih.gov/10487668/
which found that adding full-dose alendronate to ongoing HRT increased spine BMD more than HRT alone. That study (and others like it) measured BMD rather than fractures, and none of them looked at the combo as follow-up therapy after an anabolic like Tymlos. There's definitely a knowledge gap here.
The strongest evidence still supports using a bisphosphonate or Prolia to lock in the gains from an anabolic. Using HRT alone as the follow-up is less well studied, and its fracture-prevention effect is generally considered weaker than that of a bisphosphonate or Prolia. I’m taking some risk here, which is why I’m monitoring closely and sharing the related info.
If you end up using Fosamax with HRT (or HRT alone), please share your BTMs and BMD trajectory with us if you could.
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