Anyone use HRT as their immediate follow-up to Tymlos or Forteo?

Posted by annie208 @annie208, Feb 11 4:32am

I'm 63 and will finish 24 months on Tymlos six months from now. At that time, I'll have 6 final months on my commercial insurance before starting Medicare.

I'm one who is probably above-average motivated to delay using a bisphosphonate to "lock in gains" for as long as possible. I don't want to do it anytime soon because I feel like a lot of changes are afoot in this field and best practices are evolving to where more and more people are going to be "allowed" to stay on anabolics past 24 months. That excites me and I don't want to do a bisphosphonate and then dampen the future efficacy of any anabolics I might be offered.

Anyway, I've been researching new-fangled approaches to drug selection and sequencing for my impending "24-months-on-Tymlos-is-now-complete" phase. Working hard and smart on a Prior Authorization for Evenity after Tymlos intrigues me as one possibility as does the use of late-start (11 years after menopause) HRT alone for my next phase.

When we touched on possibilities for this next phase (as we often do in my appointments) my endo caught me off guard because we had just gone over extra lipid testing I had done (APOB and LIPO(a) ) and when I asked him how he was "feeling" about the eventual possibility of using over-60, late-start HRT for locking in gains he said "I have no problem with HRT for you-- your LIPO(a) is near 0 and your other numbers look good. Why do you want to wait till you're done with Tymlos? Why don't you start now and get the benefits of HRT now?"

This was a 20 minute appointment and time was up and the nurse came in and I got whisked away to get my A1C checked or some such thing. I told him I had a lot more questions and would make a longer appointment very soon--he said great/good idea, that he always forgets I'm one of his only patients who does her own research and has her own ideas (?!) and he welcomed the discussion. He said he was calling in .025 patches and 100mg micronized progesterone that day, anyway, so that I'd have them available if I decided I want to get started now.

TLDR: I believe there a couple of you on here who are using HRT as your Tymlos or Forteo or teriparatide follow-up regime... (?). If so, did any of you get started on the HRT while on the home stretch of your anabolic? Or did you wait till your course of Tymlos, Forteo, etc., was complete?

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

nycmusic | @nycmusic | Feb 11 7:32am

Annie208–very good question..I’m in the research phase and welcome these questions and hope some great discussion and expertise will light the way…wishing you the best !

mcchesney | @kathleen1314 | Feb 11 8:30am

In transitioning from Tymlos or Forteo to HRT or Bisphosphonates you are basically going from builders to keepers in terms of bone health. If you transition to BHRT and strontium citrate you are going to a keeper and a reinforcer with strontium use.
Research is limited on HRT use instead of Tymlos or Forteo:
The best direct research seems to be using HRT during Forteo treatment. Found with a google search:
"Some studies suggest that starting HRT during anabolic treatment (combination therapy) rather than just after can result in significantly greater BMD increases (e.g., 14.1% in the spine) compared to HRT alone. "
https://pubmed.ncbi.nlm.nih.gov/16418784/
Several research articles and Menopause Societies list HRT as an alternative to bisphosphonates and even to other osteoporosis drugs.
https://theros.org.uk/information-and-support/osteoporosis/treatment/hormone-replacement-therapy/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10009319/
Here is one Mayo discussion of use of HRT after Forteo:
https://connect.mayoclinic.org/discussion/forteo-teriparatide-followed-by-hrt-my-experience/
One of the many advantages of HRT and one not always discussed is:
No Long-Term Retention: Unlike bisphosphonates, which can stay in the bone for over a decade, HRT has a shorter half-life, which may be preferred by patients concerned about long-term drug accumulation.

singingbones | @singingbones | Feb 11 8:37pm

For what it's worth, I'm on the Evenity drug for a few more months (no prior med/no fractures/72 yrs). I have been on HRT for several yrs at a minimal dose for vaginal dryness--apparently not enough to significantly impact bone integrity (severe OP). I will be seeing a hormone specialist soon to evaluate strengths of hormones in light of OP. I've read several articles & medical publications (many that kathleen1314 has recommended) & testimonies that report bone density improvement with HRT and/or strontium citrate alone. When the Evenity course is completed, I plan to add strontium citrate to my current regime of supplements & hormones.

lbrown742 | @lbrown742 | Feb 13 1:19pm

I am 67 and never took hrt. My endocrinologist agreed to start me on hrt. About 6 weeks weeks later I started on Tymlos. I'm almost 3 months in and had a 297% increase in my P1NP. My hope is to continue on hrt on completion of Tymlos and see how I do. I did find a study on women ages 58 - 80 on hrt, that showed they all maintained bone density after 4 years. I would prefer to skip reclast if at all possible. I hope maybe there will be more info available in a year from now.