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
@mayblin
Thought I'd touch base again. After a few months I reread your experience above. I didn't realize before how very similar it is to mine! Looking at your beginning T scores to the post forteo/6 mo T scores we are very similar in both lumbar and hip. If I'm reading correctly: You improved from -3.4 to -2.3 in the lumbar spine. I just had my follow up dexa and meeting with endo and rheumatologist last week. I started at a -3.6 and improved to a -2.5. This is after 2 years on Tymlos and starting BHRT 6 months ago on my own. I'm taking it while finishing my last months of Tymlos. I use a .025 estradiol patch (bi weekly) and 100mg of micronized progesterone daily. You continued to improve to -1.9 after 15 months with BHRT alone and no other osteo meds??!! This is very encouraging for me!
I actually am down to my last 10 days of Tymlos and both the endo and my rheumatologist have given me the choice of Reclast (both favor this) or Alendronate. Both have changed their tune since last year when I approached them about BHRT therapy. Last year was a resounding NO! from both. I started BHRT on my own 6 months ago and this year they were both supportive. I fully expected to be told I was taking a risky path. What a difference a year makes......and updated FDA recommendations. LOL. My endo actually said the BHRT probably helped my gains as I gained more this year than my first year on Tymlos. Usually the gains aren't as much in year 2.
I have been doing a lot of reading on bisphosphonates in the last 2 years. I simply cannot wrap my head around poisoning my osteoclasts and disabling them from doing their job....only to have them all wake up and be angry and make up for lost time after I'm off of the bispho for the "drug holiday". Then to wait for the t score to drop again and start all over, and with more brittle bones from the bispho leftover effects. Reclast can stay in your bones for up to 10 years after even 1 infusion. I'm supposed to do 3 years if that is my choice. No thanks.
I intend to stay on BHRT for as long as I can speak. Learning how estrogen acts as an antiresorptive just makes so much more sense, using something that is natural without killing off an important cell that needs to remove old bone. The problem is just keeping osteoblasts up with the building part. I've never had bone markers done as none of my docs use them, or know how to use them, so I have no baseline or any idea of how they are/have responded to Tymlos and BHRT.
I haven't told either dr yet that I'm not going to do the bisphosphonate thing. I am dreading that email. They were both quite thrilled with my improvement (as was I and also I was very relieved) and I'm sure they will think I'm making a huge mistake and wasting my gains. But I have a few other ideas that I'm researching, so this journey will continue. Forever I suppose.
We're all just doing what we can!
Be well & Cheers!
Nonna
-
Like -
Helpful -
Hug
9 Reactions@psmnonna
What a great story and reply!
Would you consider going on Inspire to the Osteoporosis and maybe the Red Hot Mama community and sharing this there also. Your voice would be so appreciated.
A google search of Inspire osteoporosis community should find the site easily. I would give you a link but it just links to my profile etc.
-
Like -
Helpful -
Hug
1 Reaction@psmnonna Hi Nonna, I've just started menostar which is an ultra low dose estradiol patch for older women to hopefully prevent future OP progression. Could you tell me the dose of estradiol you've been on for this purpose?
I’ve been on teraparatide (Canadian version of Forteo called Osnuvo) for 22 months. I’m supposed to stop on April 10th and have a DEXA scan scheduled for April 2nd. I was supposed to see my endocrinologist on April 16th for a next step consult, so I was thinking of taking the drug one week longer to reduce the time in between my consult and stopping the drug. My endocrinologist has decided to go away now and can’t see me until April 30th, and I can’t get any advice from her office on whether I should stay on the drug for a month longer.
My endocrinologist is supposed to be the absolute best in Canada and is world renowned, but getting in to see her is frustrating. I’m wondering if I should start BHRT now and if that will help me hold on to my gains. What is his Menostar? I have minor calcification in one artery. Should that stop me from taking it?
I’m afraid of the Reclast injection too, but I think it’s the best option to lock in gains? I’m 67 years old, 19 years post-menopausal and very active, including aggressive downhill skiing. I started at -3.5 in spine and -2.7 in my hips. I’m hoping for -2.5 results 🤞
Any thoughts or advice?
-
Like -
Helpful -
Hug
3 ReactionsThese look like great results. I am 57 and have always been fairly active. Broke both my wrists with in one year. One snowboarding and one playing pickleball!
After DEXA scan I do have osteoporosis in L3-L4. Left hip osteopenia levels.
Just started HRT and Forteo.
Did you take both at the same time? I am only a week into Forteo and a month into HRT.
Did you find you were nauseated at all when you first started Forteo?
-
Like -
Helpful -
Hug
2 Reactions@psmnonna
First of all, congratulations on your amazing improvement! I'm truly happy for you.
It's really interesting that our starting Tscore were so similar and that we've both ended up in a similar range. From what you shared, you reached a lumbar Tscore of -2.5 after two years in Tymlos, with the last 6mo combined with HRT. In comparison, mt lumbar Tscore improved to -2.9 after 22mo on Forteo alone, and then to -2.3 after 6mo of HRT alone. My bmd gains with Forteo were modest at first, but there was a noticeable jump during the 6mo of HRT alone. This was explained to me by an endo who is familiar with btms and HRT that my high bone turnover state while on Forteo (even at the end of treatment) may have helped extend the anabolic window. I also wonder if adding HRT toward the end of your Tymlos helped continue the bone-building effect. I do wish you had bone markers tracked along the way - it would've been fascinating to see how they changed over time and what insight they might offer.
Since my table may look a bit busy, here's a short version of my sequence: 22mo of Forteo alone -> 6mo of HRT alone -> 5mo HRT plus a small overlap with Forteo (3 pens, various dosing regimen) -> HRT alone afterwards. So my last DXA wasn't purely HRT data because it still reflected that brief overlap with Forteo. The next scan will be the first one showing HRT alone, which should give a much clearer picture of whether bmd is being maintained. So far, my bone markers have been reassuring - my CTX has remained quite suppressed at low 100s on HRT alone.
Like you, I don't have a bone marker baseline. You might consider asking your doctor to order labs, or even self-order online, just to see where your CTX is at now, and especially on HRT alone in the near future. This could reassure you that your bone turnover is adequately suppressed during the antiresorptive phase on HRT alone, which will support the case that you don't necessarily need to switch to or add a bisphosphonate.
It is said that estrogen is a stronger antiresorptive than raloxifene, so it should be effective, though individual response and dosing can vary. We share the same thought that estrogen can be a more natural antiresorptive option, provided the benefits outweigh the risks. Since its effects are readily reversible, it won't "lock" bone turnover into a long term suppressed state the way some other agents might. That flexibility, especially if repeated anabolic treatment is ever needed in the future, feels like a meaningful advantage.
If you decide to check btm, you could test CTX (with or without P1NP) at 1 and 3mo after being on HRT alone. If one test is preferred, around 2mo in might be reasonable since you've already been on HRT for 6mo.
I'm really encouraged by your great news. Let's keep comparing notes as we go.
-
Like -
Helpful -
Hug
3 Reactions@didobosz13
I didn't take Forteo and HRT concurrently. I completed Forteo first and then transitioned to HRT. My bone marker labs showed that the full antiresorptive effect of HRT (estradiol patches in my case) was reached around 6-8mo after starting HRT.
The only side effect that I've experienced with Forteo was fatigue during first 5-6wks, mainly due to lowered blood pressure, which was mitigated by increasing fluid (salted at times) intake.
Are you planning Forteo + HRT for the full course of Forteo treatment? Please keep us updated!
@lynn59
I also have some mild coronary artery calcification - my cac score is 38. I consulted with 2 cardiologists, and both reassured me that HRT is reasonably safe in my case, though they both set target goals for my LDL-c and HbA1c. Have you had a chance to speak with a cardiologist about your situation?
Since HRT takes a few months to reach its full antiresorptive effect, the ideal timing for starting it isn't entirely clear. I began right after finishing Forteo, while psmnonna overlapped hers with Tymlos. In the end, both approaches seem to have worked, based on our DXA results.
Please keep us posted on what you decide and how things progress. I'm rooting for you.
-
Like -
Helpful -
Hug
2 Reactions@mkoch thank you for the information!
-
Like -
Helpful -
Hug
1 Reaction@tillymack
I am on a .025 estradiol patch and 100mg micronized progesterone capsule, daily. The patch is bi weekly. The estradiol is a low dose. I'm going to talk to my gyn after I make the 6 mo. mark, so in March, to see if I can bump up to the next dose. I'll be off Tymlos by then, so maybe need to focus on optimizing my estradiol dose. I'll also request to get my hormone levels tested. I asked at both earlier visits with her, but she said they wouldn't tell anything because of my age. Not sure I agree, so asking with more intention next time. Lol