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.

chikris | @chikris | Oct 12 1:21pm

In reply to @mayblin "@chikris Year-2 HRT DXA update I’ve now completed my two years of HRT following a course..." + (show)

@mayblin
Congrats! That's great news for you! Glad to hear the HRT is holding things steady.

willowmena | @willowmena | Oct 13 5:17am

In reply to @mayblin "@lightlifts, thank you! I stopped Forteo in July 2024 and have been on HRT ever since,..." + (show)

@mayblin I note you have been able to hold onto your bone gains with HRT, alone. I am on Tymlos for 13 months and still struggling with bone pain and sleeplessness, I want to stop injecting but refuse to use bisphosphonates. Two of my doctors refused to prescribe HRT. My PCP however allowed me the latitude of deciding for myself to weigh the risks and benefits of HRT versus possible spine or hip fracture (I have already had bi-lateral hip replacements but can still fracture). My bone density numbers are not improving under Tymlos despite good bone markers. At age 77, I am 23 years out from menopause and I understand the benefits of HRT at my age are limited. Thank you for posting your numbers, very impressive.

WilWeten | @wilweten | Oct 13 6:50am

In reply to @willowmena "@mayblin I note you have been able to hold onto your bone gains with HRT, alone...." + (show)

@willowmena if your bone markers are good, could the problem have somehow to do with the intake or absorption of calcium, vitamin D3, vitamin K2, magnesium or protein?

lightlifts | @lightlifts | Oct 13 7:28am

In reply to @wilweten "@willowmena if your bone markers are good, could the problem have somehow to do with the..." + (show)

@wilweten This is wonderful! I am considering doing the same after Tymlos. Curious if you have experienced any side effects from the HRT?
Of course everyone is different.
Thanks so much for your insight.

willowmena | @willowmena | Oct 13 10:20am

In reply to @wilweten "@willowmena if your bone markers are good, could the problem have somehow to do with the..." + (show)

@wilweten Yes, although those numbers are good, as well. But because I suffer from chronic pancreatitis for which I take digestive enzymes with all food, I still could have a functional deficiency that does not show up in conventional bloodwork. Malabsorption is likely a major contributor to my osteoporosis. My doctors so far have no answers. I need one who thinks outside of the box!

gravity3 | @gravity3 | Oct 13 11:13am

In reply to @willowmena "@wilweten Yes, although those numbers are good, as well. But because I suffer from chronic pancreatitis..." + (show)

@willowmena

Have you tried using a functional medicine practice?

willowmena | @willowmena | Oct 13 2:17pm

I did not because they are all concierge and quite expensive. However, yesterday I saw my primary care physician, and I made the case for my concern about possibly experiencing hip fractures and what that could mean for me in terms of fatality versus the dangers if any of HRT at my age post menopause and she allowed me to make that decision so that I now have low-dose patch and progesterone micronized. I think I would like to get my DEXA scan redone before starting on the patch. I’m scheduled for January, but I’m gonna move it up and see if they can get a reading on my cortical bone on my Radius forearm. It will not be the same facility or the same machine which I felt was hugely inadequate. That DEXA last year did not even provide a number for my spine at all, merely stating it was unremarkable. Totally ridiculous. In any rate, I think a baseline pre-HRT would be a good idea. I really want to get off of Tymlos because the side effects are so troubling for me and a full dose destroys my sleep completely with weird dreams and bone pain during the night. I’m currently at 70 MCG rather than 80. Sorry if this is repeating what I previously posted but of course I have no memory either.

mayblin | @mayblin | Oct 13 4:00pm

In reply to @willowmena "@mayblin I note you have been able to hold onto your bone gains with HRT, alone...." + (show)

Thank you very much, @willowmena

It sounds like your recent DXA did not show the BMD gains you were hoping for, even though your bone turnover markers responded well. If you’re comfortable sharing, I’d be interested to know what your BTM and DXA numbers showed. I hope you can stay on Tymlos a few more months longer, maybe follow what BTMs are telling you to maximize bone building.

As you know, guidelines recommend that a full course of a PTH analog (such as Tymlos) be followed by an antiresorptive agent to help maintain the gains. The Endocrine Society specifically lists menopausal hormone therapy as an acceptable sequential option, alongside bisphosphonates, raloxifene, or denosumab. Finding a physician willing to prescribe MHT at later stage of menopause can be challenging, so it’s nice to know that one of your doctors was open to shared decision-making on the age-related risks and benefits, and that you’ve already received the HRT prescriptions. I also think it’s a good idea to get a new “baseline” DXA before you start, unless you’ve just had the scan recently. Will you be monitoring your BTMs as well after you start HRT?

Wishing you the best as you begin this next phase - please keep us posted on how it goes.

willowmena | @willowmena | Oct 13 6:25pm

In reply to @mayblin "Thank you very much, @willowmena It sounds like your recent DXA did not show the BMD..." + (show)

@mayblin My bone turnover markers in September, just 1 year after starting Tymlos, were P1NP 129, and 809 CTX. That was my first CTX as the endo insisted on utilizing outdated NTX testing. My DEXA of July 2025 showed a -3.2 forearm radius. No readings for the bi-lateral hip prosthetics, of course. My spine is considerable damaged from horseback riding accident (fractured my neck at C-1) and from years of lifting heavy packages in my business. Also ran long distance for 40 years. Not the body of my youth! LOL. I will request an earlier DEXA from scheduled January appt. and then begin HRT. Will definitely continue to monitor BTMs. Hopefully can overcome the nutritional challenges from my chronic pancreatitis that contributes to the bone loss, for sure.
Thank you for your good wishes. I will post updated info.