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.

vmcgrantham | @vmcgrantham | 6 days ago

In reply to @gravity3 "@vmcgrantham What are the reasons he is suggesting reclast and Prolia rather than an anabolic first?" + (show)

@gravity3 she told me I was too old for HRT or any estrogen and I have been on Forteo for 8 months but I do have an autoimmune graves disease and past kidney stones. I am in the middle of getting dental work done and it has taken a while too heal. I have to be careful. jaw necrosis is a worry of mine but kidney is the biggest worry. and autoimmune make my body fight everything it is hard to deal with. she won't even talk about estrogen and I was wondering about taking the Optimum Shilajit and was wondering if anyone tried it. so recast has kidney and jaw problems so does Prolia. Evenity has blood clots, heart attack and stroke which scares me. I want to live not die. so I am trying to find something that I can take to help without all this. like you try to treat your bones but then you have to worry about other more scary problems.

gravity3 | @gravity3 | 6 days ago

In reply to @vmcgrantham "@gravity3 she told me I was too old for HRT or any estrogen and I have..." + (show)

@vmcgrantham
Only a problem if you get any of the listed possible side effects.
I've taken fosomax/alendronate, forteo, evenity and now Prolia. No noticeable side effects from any of them.

Too old according to what source. Is she up to date on latest. The YouTube videos of Dr. Susan Hardwick-Smith are quite useful.

mayblin | @mayblin | 6 days ago

In reply to @dezzie "So interesting. My neurologist wants me to add an anabolic to the mix but when I..." + (show)

@dezzie, are you on HRT now?

I’ve been on HRT a little over 2 years now since finishing Forteo, and I’m not sure how well it’s maintaining my BMD in the second year - I’m waiting for the DXA scan next month.

2024tymloshelp | @2024tymloshelp | 6 days ago

Please keep us posted on how well HRT has worked to prevent resorption after forteo gains

vmcgrantham | @vmcgrantham | 6 days ago

In reply to @gravity3 "@vmcgrantham Only a problem if you get any of the listed possible side effects. I've taken..." + (show)

@gravity3 I don’t have much problem with the forte at all, but because of my autoimmune it kicks up things a lot more I don’t know, but I don’t know if she’s up-to-date on her stuff or not I couldn’t tell you that but I would love to try that, but I would also like to try that optimum shilajit

dezzie | @dezzie | 13 hours ago

In reply to @mayblin "@dezzie, are you on HRT now? I’ve been on HRT a little over 2 years now..." + (show)

@mayblin yes i am on hrt and just figuring out my next move.

mayblin | @mayblin | 10 hours ago

In reply to @dezzie "@mayblin yes i am on hrt and just figuring out my next move." + (show)

@dezzie
You may be interested in this clinical study:
https://onlinelibrary.wiley.com/doi/10.1359/jbmr.2001.16.5.925
52 postmenopausal women with osteoporosis on established HRT (longer than 2yrs) were randomized to add PTH(1-34) or to continue HRT alone for 3 years. BMD and bone turnover markers were monitored every 6mo, and vertebral fracture was evaluated as well. Subjects were reassessed 1yr after PTH discontinuation while HRT was continued.

This is a small study, though, and it does not address whether PTH1-34 + HRT is superior to PTH1-34 alone.

dezzie | @dezzie | 5 hours ago

In reply to @mayblin "@dezzie You may be interested in this clinical study: https://onlinelibrary.wiley.com/doi/10.1359/jbmr.2001.16.5.925 52 postmenopausal women with osteoporosis on..." + (show)

@mayblin I remember getting a spontaneous collapsed lung years ago. They couldn’t figure out what was wrong with me even though I went to 2 different GPs. I asked the specialist why they couldn’t diagnose it “you are not textbook”. I think this study puts it out there for HRT and PTH combos. It gives researchers the opportunity to explore the dynamic and consider things from another angle. We are not all textbook. Thank you so much for sharing this. I really appreciate it