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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.
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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.
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@ipg
It’s good to know you’ve been doing well since 2005 - your worry is understandable.
I don’t know much about dormant cancer cells and their reactivation, but the prescribing information for Forteo lists these under Warnings and Precautions:
- Bone metastases or a history of skeletal malignancies
- Prior external beam or implant radiation involving the skeleton
Thyroid cancer isn’t specifically listed. Given your history, though, an individualized risk assessment with your oncology and endocrine teams is probably the safest approach.
On HRT - estrogen (any dose) is labeled for prevention of postmenopausal osteoporosis, not treatment of established osteoporosis. Your doctor may be weighing your bone density, fracture risk, and overall history when making recommendations.
I used Forteo as my first treatment with good results and I wish you the best on your bone journey.
@mayblin
Did u have side effects with Forteo? I believe Forteo is more to improve bone density in spine rather than hip. Mine is in hip. I was at a party where a person told me that she previously passed out two times from Forteo and was taken to the ER.I am at risk for MRONJ. Where did you go from there? I am 70. 20 years post menopause.This is unbearable for me. Please advise
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1 ReactionMy docs all worry about hormones for 81yo F….maybe cholesterol needs to lower to qualify ?
@ipg I'm on Tymlos a little over a year it's similar to Forteo.
I did have a 13.5 increase in my spine and a 9. increase in my hips. I never passed out from it did feel a little light headed the 1st few times I used it but went to sleep right after..I did feel fatigued the first 6 months or so and kept my dose at half for that time. I don't know if the Forteo pen can be adjusted for a lower dose as the Tymlos 1 can. I'm still not on the full dose. I'm on 7 clicks on the pen instead of 8. Both Forteo and Tymlos have to be followed up by a bisphosphanate like Reclast or Prolia or maybe Evista ( not good for me) or maybe Evenity( again not good for me) to lock in your gains. I see your concern about the jaw. I can't take any oral meds due to my stomach and am frightened of the Reclast and Prolia can never be stopped. I never heard of anyone passing out from an anabolic. Good luck to us all.
@lightlifts
Why not Evista or ever? Please advise. Any other side effects with Tymlos?
@ipg
Are you also doing your own research. I think that most of us have discovered along this path that is very important. Not every doctor has the experience and training in treatment for Osteoporosis. We must act as our own best advocates.
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3 Reactions@gravity3
I am researching as much as possible. I wake up thinking about it and go to bed thinking about it. It’s awful
Thanks
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4 Reactions@ipg
It's so overwhelming at first but it gets better you are not alone!!! Remember to take breaks.
@ipg, i was very lucky and only had some mild fatigue during the first two months on Forteo. Please remember side effects can vary a lot from person to person.
I followed with estrogen and plan to stay on it as long as I can.
Hope you find a path that works for you.
@nycmusic, since HRT has systemic effects, an individualized risk/benefit assessment is important. Evaluation of cardiovascular risk by a cardiologist and breast cancer health history would typically be considered before making a decision.
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