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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.

⸻

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.

⸻

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.

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gravity3 | @gravity3 | Sep 29 10:01am
In reply to @mayblin "@chikris Year-2 HRT DXA update I’ve now completed my two years of HRT following a course..." + (show)
Profile picture for mayblin @mayblin

@chikris
Year-2 HRT DXA update

I’ve now completed my two years of HRT following a course of Forteo. While this is simply my own experience, the results may still be of interest to others on a similar path, given how limited the data remain on transitioning from an anabolic agent specifically to estrogen.

Compared with last year’s DXA scan, L1-L4 spine and total hip BMD are holding steady, with the total hip showing a slight increase. I have not included the femoral neck measurement because of an unusually large jump this time. Such changes can result from small differences in leg positioning or technique (to which the femoral neck is particularly sensitive) and may not reflect a true biological change of that magnitude. All scans were performed on the same machine by the same tech.

TBS showed a modest decrease. I remain fracture free.

I’ve been using low-dose 0.025 mg/day transdermal estradiol patches throughout. Nutrition and supplements were fairly consistent over the past year; exercise and sleep less so. CTX during the second year of HRT stayed under 120 pg/mL, indicating a consistent response to estrogen. Two blood estradiol measurements came back at 42 and 50 pg/mL (baseline at 18), showing adequate absorption with no clear correlation to the timing of patch application.

Plan is to continue as is.

Any questions or thoughts are welcome.

Jump to this post

@mayblin

Thank you for this great info. Congratulations!

REPLY
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luckypup | @luckypup | Sep 29 10:13am
In reply to @mayblin "@chikris Year-2 HRT DXA update I’ve now completed my two years of HRT following a course..." + (show)
Profile picture for mayblin @mayblin

@chikris
Year-2 HRT DXA update

I’ve now completed my two years of HRT following a course of Forteo. While this is simply my own experience, the results may still be of interest to others on a similar path, given how limited the data remain on transitioning from an anabolic agent specifically to estrogen.

Compared with last year’s DXA scan, L1-L4 spine and total hip BMD are holding steady, with the total hip showing a slight increase. I have not included the femoral neck measurement because of an unusually large jump this time. Such changes can result from small differences in leg positioning or technique (to which the femoral neck is particularly sensitive) and may not reflect a true biological change of that magnitude. All scans were performed on the same machine by the same tech.

TBS showed a modest decrease. I remain fracture free.

I’ve been using low-dose 0.025 mg/day transdermal estradiol patches throughout. Nutrition and supplements were fairly consistent over the past year; exercise and sleep less so. CTX during the second year of HRT stayed under 120 pg/mL, indicating a consistent response to estrogen. Two blood estradiol measurements came back at 42 and 50 pg/mL (baseline at 18), showing adequate absorption with no clear correlation to the timing of patch application.

Plan is to continue as is.

Any questions or thoughts are welcome.

Jump to this post

@mayblin Wow! this looks like great news! ...for you and giving hope to some of the rest of us 🙂
Thank you for sharing it!

REPLY
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bluebonnet242 | @bluebonnet242 | Sep 29 10:17am

This is such great news! Not only have you kept your gains, your BMD has increased. I’m so happy to see this!

Do you take k2 and if so mk4 or mk7?

REPLY
1 reply
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mayblin | @mayblin | Sep 29 7:04pm
In reply to @bluebonnet242 "This is such great news! Not only have you kept your gains, your BMD has increased...." + (show)
Profile picture for bluebonnet242 @bluebonnet242

This is such great news! Not only have you kept your gains, your BMD has increased. I’m so happy to see this!

Do you take k2 and if so mk4 or mk7?

Jump to this post

Thanks @bluebonnet242. BMD has stabilized, which was my primary goal with HRT, and my doctor is pleased with the results too. The slight increase at the total hip is definitely the icing on the cake.

I get vitamin K2 from food sources - specifically MK-7 from natto. When I’m traveling I use InnovixLabs K2 gelcaps (500 mcg MK-4 + 100 mcg MK-7). My endo is neither for nor against supplementation, citing insufficient evidence.

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ipg | @ipg | Oct 2 2:37pm
In reply to @mayblin "@chikris Year-2 HRT DXA update I’ve now completed my two years of HRT following a course..." + (show)
Profile picture for mayblin @mayblin

@chikris
Year-2 HRT DXA update

I’ve now completed my two years of HRT following a course of Forteo. While this is simply my own experience, the results may still be of interest to others on a similar path, given how limited the data remain on transitioning from an anabolic agent specifically to estrogen.

Compared with last year’s DXA scan, L1-L4 spine and total hip BMD are holding steady, with the total hip showing a slight increase. I have not included the femoral neck measurement because of an unusually large jump this time. Such changes can result from small differences in leg positioning or technique (to which the femoral neck is particularly sensitive) and may not reflect a true biological change of that magnitude. All scans were performed on the same machine by the same tech.

TBS showed a modest decrease. I remain fracture free.

I’ve been using low-dose 0.025 mg/day transdermal estradiol patches throughout. Nutrition and supplements were fairly consistent over the past year; exercise and sleep less so. CTX during the second year of HRT stayed under 120 pg/mL, indicating a consistent response to estrogen. Two blood estradiol measurements came back at 42 and 50 pg/mL (baseline at 18), showing adequate absorption with no clear correlation to the timing of patch application.

Plan is to continue as is.

Any questions or thoughts are welcome.

Jump to this post

@mayblin
Wonderful news!. At 70 my drs won’t give me HRT. Please remind me as to how old you are?

REPLY
2 replies
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gravity3 | @gravity3 | Oct 3 12:58am
In reply to @ipg "@mayblin Wonderful news!. At 70 my drs won’t give me HRT. Please remind me as to..." + (show)
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@mayblin
Wonderful news!. At 70 my drs won’t give me HRT. Please remind me as to how old you are?

Jump to this post

@ipg

Try Dr. Susan Hardwick-Smith on YouTube. She has a number of helpful videos.

REPLY
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lightlifts | @lightlifts | Oct 3 6:14am

So you never did Reclast or any bisphosphonates after Forteo or maybe you haven’t transitioned off Forteo.
I will be 70, 16 years post menopause. Will be transitioning off Tymlos next year. Doubt I can get HRT. So happy for you!

REPLY
2 replies
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gravity3 | @gravity3 | Oct 3 7:13am
In reply to @lightlifts "So you never did Reclast or any bisphosphonates after Forteo or maybe you haven’t transitioned off..." + (show)
Profile picture for lightlifts @lightlifts

So you never did Reclast or any bisphosphonates after Forteo or maybe you haven’t transitioned off Forteo.
I will be 70, 16 years post menopause. Will be transitioning off Tymlos next year. Doubt I can get HRT. So happy for you!

Jump to this post

@lightlifts

I started bhrt at 77 with a functional medicine provider. Below is another resource.

Dr. Susan Hardwick-Smith YouTube

REPLY
2 replies
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lightlifts | @lightlifts | Oct 3 10:10am
In reply to @gravity3 "@lightlifts I started bhrt at 77 with a functional medicine provider. Below is another resource. Dr...." + (show)
Profile picture for gravity3 @gravity3

@lightlifts

I started bhrt at 77 with a functional medicine provider. Below is another resource.

Dr. Susan Hardwick-Smith YouTube

Jump to this post

@gravity3 so you didn't do it transitioning off an anabolic.
Idk if it's for me with my family history. So far they've told me no. I'll do more research. Thank you

REPLY
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md79 | @md79 | Oct 4 12:26pm

Very promising results! I am very happy for you and very thankful for sharing your data.
I am 70 y.o. with early (at age 34) surgical menopause, and I was on HRT (Premarin) until age 50, when WHI information massed up with many of us, and I left with no hormone replacement.
At the beginning of spring I broke my T 11 vertebra with 40% compression. My DEXA was at an osteopenia level, with a spinal T-score of -1.9 and a hip score of -0.6. My bone marker score was 180 ng/mL at the time of fracture. Two endocrinologists' opinions were different: one insisted on starting Forteo and the other on Prolio. I chose the less harmful Forteo. I'm in my 3rd month on Forteo and want to end at the 6th month mark due to some side effects. I am also started transdermal estradiol 0.025 mg with Forteo. I have a big doubt about whether my gynecologist willing to increase the dose of the estradiol patch to at least up to 0.075. If not, I will try to find a reliable Dr. Naturologist.
You mentioned that you used three leftover Forteo pens with off-label dosing. I also thought about that. Can you please share how you dose? For example, instead of abruptly stopping daily injections, can I use maybe three than two and then once a week?
Another question is: the transdermal patch estradiol dose depends on the skin barrier and absorbability. So we need to rely on measurable serum estradiol levels. Mine at the time of fracture was low: 23 ng/mL, which is less than expected for "Female Post Menopausal <25.1". I don't need progesterone because I had a hysterectomy.
Did you increase the dose of bHRT?

Thank you very much for sharing with us your great success. I am so happy for you!

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