Connect
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.
⸻
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.
Like
Helpful
HugInterested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.
Connect
Hello, I read your original post and the thread you started with great interest as I am in a very similar situation to the one you were in when diagnosed at 59 years old. Is there any news you can share? Thank you and kind regards.
…and I have a specific question: what time of the day did you inject Forteo? There is only one small study on 50 people which seems to indicate better results if teriparatide is injected in the morning but I did not see any such recommendation on the prospect or on any of the medical sites specialized in osteoporosis and teriparatide treatment. Thank you and kind regards.
-
Like -
Helpful -
Hug
2 Reactions@gravity3
Are you taking HRT or are thes benefits you mention such as improved muscle mass retention, etc. from Forteo? Either way sounds great!
Thank you!
@ioana
I've read that study as well, which suggests slightly greater BMD gains with morning dosing. This finding hasn't been followed up in larger trials, which may explain why it hasn't led to any formal recommendations.
Coincidentally, i injected at night during my first year (mainly to "sleep off" any side effects), then switched to morning injections during my second year. I saw similar gains for lumbar spine during both periods, with the exception of noticeable bmd gains in the total hip and femoral neck during second year - which is not unexpected, since hip and femur neck tend to respond more slowly and are harder to improve.
I'm now in maintenance mode with HRT, with periodic bone turnover marker testing and yearly DXA scans. My next DXA isn't due until 9/2026, and we'll see then what the data show.
Are you on Forteo now, and thinking about HRT as a next step after Forteo?
@tillymack
Those benefits I attribute to bhrt. Forteo treatment ended about 8 years ago.
@mayblin Can you tell me what HRT treatment consists of? I’m going on my second year of Forteo and am interested in post 2nd year options. Thank you!
@yvettenie
I can list what I take if that will help you:
Estradiol testosterone pellet
Progesterone capsules
Estradiol vaginal cream
-
Like -
Helpful -
Hug
2 Reactions@gravity3
I didn't realize your Forteo treatment ended so long ago! After Forteo, did you take any other OP meds? How long after Forteo treated ended, did you start HRT? Many thanks!
@tillymack
After forteo I resumed alendronate for an additional 3 years, then Evenity. Now on prolia. Just started bhrt one year ago at 76.
@yvettenie
I am using transdermal estradiol 0.025mg/day patches, with nightly oral micronized progesterone 100mg for endometrial protection. Both are bio-identical, prescribed by my obgyn.
Please keep us posted on how things are going.
-
Like -
Helpful -
Hug
3 Reactions