Forteo (teriparatide) followed by HRT: My Experience

Posted by mayblin @mayblin, Sep 29, 2025

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.

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

mayblin | @mayblin | Sep 22 11:14am

In reply to @ipg "@mayblin May I ask how old you are. ? I’m 70" + (show)

@ipg, 63, started HRT at 61, or 11 years post-menopause. You can find my treatment info in the original post of this thread.

mayblin | @mayblin | Sep 22 11:21am

In reply to @chikris "@mayblin I was just following up to see if you did have your follow up dexa..." + (show)

@chikris, scan in a week. I’ll post the results here once they’re available. Hoping for BMD stability 🤞

clandis3352 | @clandis3352 | Sep 23 3:41pm

Ive been on Tymlos 4 months. A long side I’m also on low dose estrogen. I wanted to take Menostar a new estrogen to prevent osteoporosis.
Studies have shown that Tymlos and estrogen build better bone.
Hoping to stay on estrogen and forgo reclast.
I’m 76 with no cancer in family.

nancytheyda | @nancytheyda | Sep 24 8:13am

Hello . Thanks for sharing all that about Forteo and HRT
. Did you experience any adverse side effects?
Thanks, Nancy

mayblin | @mayblin | Sep 24 9:33am

In reply to @clandis3352 "Ive been on Tymlos 4 months. A long side I’m also on low dose estrogen. I..." + (show)

@clandis3352, please keep us updated with your treatment progress if you're comfortable doing so.
If you don't mind sharing, any bone turnover markers (if you're monitoring them) or DXA results will be really helpful to see.

mayblin | @mayblin | Sep 24 9:39am

In reply to @nancytheyda "Hello . Thanks for sharing all that about Forteo and HRT . Did you experience any..." + (show)

@nancytheyda
Hi Nancy, I was very fortunate not to experience any major side effects with either. Forteo - I only had some fatigue during the first month or two. With HRT, I had tolerable breast tenderness for about 6 months. Hope this helps!

clandis3352 | @clandis3352 | Sep 24 10:16am

In reply to @mayblin "@clandis3352, please keep us updated with your treatment progress if you're comfortable doing so. If you..." + (show)

@mayblin
I will. I’m new to the group. I find it very informative.
Tymlos and estrogen are compatible. One builds bone, one stabilizes gain.
There’s possible problems with taking estrogen at my age but reclast also can be problematic.
I’m at 12.5 estrogen patch. Take progesterone for two weeks every 6 months.
I’m having a DEX scan in two weeks.
My scores a year ago were -4 in hips.

hazell | @hazell | Sep 24 7:37pm

What type of doctor did you see that prescribed you Forteo & Estrogen? How old are people commenting on this topic? I'm 68. My PCP tried to get me to take Evenity, but I'm very disappointed on conversation about other options or additional testing. She didn't know anything about other options, other than PCP can now prescribe Evenity. So that's what they are pushing. I had been on Risedronate for 5 yrs. She referred me to an Endocrinologist, but I can't get in to see him until May 2027! My Dexa on lumber went from -3.0 in 2024 to -3.6 in July 2026. So for now, I'm on my own to figure out options and find other doctors. Very disappointed in medical doctors right now. I'm working with my RD on supplements & diet. Will start more strength training. Already do lot of yoga, pilates, and walking. Any recommendations greatly appreciated.

mayblin | @mayblin | Sep 25 8:24am

In reply to @hazell "What type of doctor did you see that prescribed you Forteo & Estrogen? How old are..." + (show)

@hazell
I was diagnosed at age 59 and referred to an endocrinologist. Other specialists who treat osteoporosis include rheumatologists and metabolic bone specialists. And yes, the wait for the initial appointment can be quite lengthy.

My HRT is prescribed by my OBGYN who, together with a cardiologist, evaluated the risks and benefits before prescribing.

kfhoz | @kfhoz | Sep 25 10:45am

In reply to @hazell "What type of doctor did you see that prescribed you Forteo & Estrogen? How old are..." + (show)

@hazell Starting with Romosozumab (brand Evenity) is pretty good and sooo much better than starting with Alendronate (brand Fosamax) that I am encouraged by what you say about the progress being made in the medical community!

Much of the research for osteoporosis medications and treatments are from recent years, some from THIS year. There is no way that regular doctors can keep up on this and all the other conditions that come through their offices. I was unfortunate to naively allow myself to be put on alendronate (a generic version of Fosamax) for 18 months before a friend with OP alerted me that it would interfere with bone-building meds such as romosozumab (Evenity) if I ever needed them.

The upshot is that we all have to do our own investigations. Tip: some research only refers to the medications by their base drug names, not the brand names. So when you do searches it gets best results to do 3 searches, one with both names, e.g both Abaloparatide and Tymlos, then searches with only one of each name.

My doctors specialize in patients 65+ so know more about this common disease among us senior citizens. They were willing to take me off of alendronate and put me on HRT. To that I have added LIFTMOR type weight lifting. If my next 2-year DEXA in about 13 months, does not shown improvement then it is teriparatide or abaloparatide for me.