Forteo (teriparatide) followed by HRT: My Experience

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?

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?

@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

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?

@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.

@lynn59
Oh sorry,,, should have also mentioned that my estradiol is a patch not a pill. The form you use does make a difference as far as risk factors. Mine is not the Menostar brand, but I think Menostar is a patch as well. (?) The patch delivers directly to your bloodstream and does not require being processed through the digestive system, liver, etc. where any issues, if they happen are slightly increased because of this.

I'm sure you have increased nicely after 22 months of teriparitide. I feel the same about Reclast. To the point that I'm not going to do it. I'm also active, but your downhill skiing has to be a help to your density. You definitely have impact and push and pull on your bones. I lift weights and do a lot of weighted jumping. Hoping that is doing something.

Sorry if this is kind of a disjointed reply...trying to watch the olympics (snowboarding....talk about impact?!?!) and type!
Cheers!

@lynn59
You might ask copilot until you can speak with your doctor. Ask it to check all research and standard practices.

Artery calicification....might do some research on Vit k2; it has shown great in research trials for redirecting calcium and undoing calcification. There was even a book written about the phenomenon. Vitamin K2 And The Calcium Paradox.
https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.121.057008.

@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.

@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.

@mayblin thanks as always for response. I have talked to my cardiologist about it and he felt I should stick with the osteoporosis medications, as he said there are decent choices out there now. He wasn’t completely against BHRT, but he felt the risks may not outweigh the benefits. He said pulmonary embolisms are likely my biggest risk with estrogen. I’m 18 years post menopausal and 67 years of age. You were right on the cusp of the medical arbitrary cut-off of 10 years post-menopausal and 60 years. of age. I do really want to go on it, but I am afraid. Strokes and embolisms are killers, not just side effects. And that’s what scares me, yet I’m still strongly pulled to it as it just feels more right than Reclast.