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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.

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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.

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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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chikris | @chikris | 6 hours ago
In reply to @mayblin "@drsuefowler, i hope my previous reply didn't inadvertently add any anxiety! 1mo is not going to..." + (show)
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@drsuefowler, i hope my previous reply didn't inadvertently add any anxiety! 1mo is not going to cause a noticeable change in bmd after Tymlos, even while you and your doctors are still determining how you respond to this HRT dose for maintenance.

You are right that the ctx and p1np targets in that study are quite low - and it’s important to note that the study cohort was made up of fracture patients, rather than people specifically transitioning from an anabolic like Tymlos. While this JBMR Plus article explicitly sets those BTM targets, trials such as ACTIVExtend (Alendronate after Tymlos) used strong bisphosphonates to ensure bone turnover is kept low enough to 'lock in' those gains.

Using bone markers for decision making isn't yet standard clinical practice but transitioning to a strong antiresorptive is the go-to strategy for maintenance after anabolic treatment. The availability of various estrogen dosages gives us the advantage of being able to 'titrate' to the desired effects.

I had similar observations as you did - both of my ctx and p1np are very low and they don't change much whether I was active or not. In a way, im having the opposite concern: im not sure if staying in my current low bone turnover state is ideal for very long periods.

To add one more point: if you have extra Tymlos pens and want to use them with Menostar, why not? Those pens are expensive! I actually used my 3 leftover Forteo pens myself with HRT for short periods. Ideally, Id have preferred to wait and use them after at least 1yr break, but the pens were near expiration date. Even though the 3 pens didn't give a huge anabolic signal, my L-spine gained an additional 5%. My endo pointed out that while the estrogen was reducing my turnover, Forteo had likely reached its limits after 22 months anyway. There are several ways to explain that gain or btm, but it clearly helped lock in the progress regardless.

Jump to this post

@mayblin

My comment may be a little out of order in these posts, but wondering if you have a long term plan for using HRT or if you intend to transition to something else after a certain number of years? Have you had a dexa since only being on HRT?

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mayblin | @mayblin | 25 minutes ago
In reply to @chikris "@mayblin My comment may be a little out of order in these posts, but wondering if..." + (show)
Profile picture for chikris @chikris

@mayblin

My comment may be a little out of order in these posts, but wondering if you have a long term plan for using HRT or if you intend to transition to something else after a certain number of years? Have you had a dexa since only being on HRT?

Jump to this post

@chikris
My tentative plan is to stay on HRT as primary (and only) maintenance tool, though I am prepared for Forteo retreatment if my DXA scores show significant regression - specifically if the L-spine Tscore drops to -3.0 or the total hip to -2.5. I’m comfortable using HRT for at least 5yrs, at which point I’ll re-evaluate based on the latest data regarding breast cancer risks. Raloxifene could be one of my back-up options as an antiresorptive.

I actually have a DXA coming up in a few months, which will provide the first objective look at how my BMD is holding up on HRT alone. So far, my resorption markers have been consistently low during second year of HRT, and I'm hopeful this will translate to BMD stability on the DXA 🤞

Are you currently on any treatment?

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