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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, 63. It was answered last time - see
https://connect.mayoclinic.org/comment/1676914/
An email notification should have been sent out as I tagged you. You might’ve missed it.
@lightlifts, thank you!
I stopped Forteo in July 2024 and have been on HRT ever since, without a bisphosphonate.
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1 Reaction@mayblin
Thanks. I am 70. 20 years post menopause - 3 drs refused .
Sorry for making you repeat
@md79,
Thank you!
Sorry to hear about your fracture. I hope your recovery is going smoothly, and I’m glad you’re on teriparatide now.
Thanks for your inquiry. I used 3 leftover Forteo pens during months 7–11 of my HRT treatment, primarily hoping to have additional bone formation and avoid wasting the pens. Because my response to my original Forteo course had been quite large, I discussed it with my endo and used the first 2 pens every other day, then the third one daily. I wouldn’t take my experience as a model for changing your current treatment, though.
Since estrogen is primarily an antiresorptive in mature adult bone - it helps preserve bone by slowing resorption - I think the main thing to discuss with your endo is whether there are ways to manage the side effects so you can continue the bone-building treatment and get the most benefit from your teriparatide course. 6 months is a relatively short time for a first anabolic course (for PTH analog) especially when you’re starting after a fracture. For me, increasing fluid intake (sometimes with a little extra salt) helped with my fatigue, although obviously that may not apply to everyone.
Regarding HRT, I’ve stayed on the 0.025 mg/day estradiol patch without changing the dose because my BTMs show a good response and my BMD has been stable. I know some people use higher-dose patches for bone benefits, but I’d discuss that with the endocrinologist first.
If you’re monitoring BTMs, I’d also be cautious about changing both the teriparatide dosing interval and estradiol dose at the same time, since that could make the subsequent BTM changes much harder to interpret.
Please keep us updated with your progress. Best luck to you!
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4 Reactions@mayblin Thank you!
@mayblin
Thank you so much for your time to share and explain your journey in osteoporosis treatment. It is very helpful to hear what others are doing and how to proceed with your own treatment.
Best of luck to all on your journey of building and maybe reversing osteoporosis!
Thank you!
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2 Reactions@ipg
No worries at all! Emails can get overwhelming sometimes. There’s a Notification Center here on Connect - the alarm bell icon at the top right for any replies or responses directed to you. In case you are not aware, you can also go to your (or others’) profile and search through past comments.
With HRT risk assessment, a lot of doctors get pretty cautious once you’re that far past menopause. It depends a lot on each person’s medical history.
@mayblin
They refuse
@gravity3 Two of my doctors (endo and Gyn) absolutely refuse to give me HRT due to my age of 77 and also that I was on HRT post-menopause for only 3 years and stopped at age 55 because of a family history of breast cancer. The gyn said there were heart considerations but my cardiologist has no objection to my trying it. Did you also experience resistance from conventional doctors?
@willowmena
Yes I did. I use a functional medicine provider. I am not recommending my path. It is specific to goals and desires I had for creating what for me is more quality in my life. First and foremost I wanted my libido back. Very, very important to me after years of hormone loss related lack .