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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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Neither my PCP, endocrinologist or gynecologist will discuss the possibility of HRT when I've asked them about it, I don't know how to get them to listen to me. I don't have any of the risk factors like previous cancer or cardiac problems and no family history of those things.
@willowmena Have you had any side effects from the HRT? I'm thinking of doing the same..Thank you.
@willowmena
Thanks for sharing. It looks like your lumbar spine isn’t reliably interpretable because of earlier injuries and degenerative changes. On top of that, the bilateral total hip replacements mean the hips can’t be used for tracking density either - so the forearm is essentially the only measurable site left.
As you know, the distal 1/3 radius is almost entirely cortical bone and tends to be relatively “unresponsive” to anabolic agents like Tymlos. If you have two years of forearm scans done on the same machine (ideally the same arm and positioning), you could ask the radiologist to go back and re-read the ultradistal (UD) radius - a nearby site that contains more of the responsive trabecular bone, and compare the raw density numbers (g/cm^2). That may pick up gains the 1/3 radius site would miss. Alternatively, it might be worth exploring whether QCT or BCT could be feasible down the road.
Your P1NP did show a clear anabolic response to Tymlos at the 1yr mark, and that number very likely understates the peak response you actually had. Both biomarkers (CTX and P1NP) will continue to be really useful tools for assessing response when BMD measurement is challenging.
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2 Reactions@lightlifts I just had the prescription filled and have not yet begun taking it because I want to have a DEXA for a baseline. I may also get a cardio calcium test in the event I give up Tymlos completely and try to move to something else like Evenity. That assumes that my doctors give that a thumbs up. I really prefer to only be on HRT, but I suspect I’ll need something else in addition.
@mayblin good information but the original DEXA scan in 2025 provided almost no decent information other than the cortical bone at Radius forearm. There were no numbers offered for the spine and the comment was unremarkable for the result. And that was my hospital network system. They even did the scan on my left arm without asking me, which was my primary arm, which happens to be my left. So the scan should’ve been run on my right arm and wasn’t done that way. I did not know that at the time. I just don’t have a good feeling about the Holy Cross Hospital Hospital network and the radiologist so I am going to use university of Miami for my next DEXA scan. Neither one apparently provides a TBS reading. What good is that? As for QCT, nowhere to be had in South Florida, and not even in central Florida. I’ve checked with many scanning facilities, both Private and hospital network and I cannot find the ability as an individual to have a QCT.
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1 Reaction@erinz
What are their reasons for not discussing bhrt with you? It must be infuriating that they won't discuss it and give you their reasons.
Check out Dr. Susan Hardwick-Smith on YouTube
I use a functional medicine provider.
I don't know the reasons that they won't discuss the HRT, just that both the PCP and endocrinologist said I should speak to the gynecologist, who said I've been menopausal for 15 years and that it's too late now for HRT. I didn't know anything about HRT until I joined this forum. Now that I know more about how much it could help osteoporosis, I wonder why the gynecologist I used to have, who's retired now, never mentioned it when I was going through menopause. I didn't know anything about osteoporosis at the time and feel rather "cheated" knowing that he probably could have helped me with this a long time ago.
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1 Reaction@lightlifts I also have a potential problem with endometrium thickening so I’m undergoing an ultrasound for that before I start the HRT. I took a medication called osphena and I was on it for six years. My Gyn at the time did not really monitor the length of time that I was on it even though he prescribed it. The clinical studies only looked out as far as 18 months for side effects, but one of the potential side effects was thickening of the endometrium and that’s how it affected me so I have to be particularly careful of that with HRT. I’ll be taking progesterone for that reason.
@erinz
After it was revealed that the women's health initiative study is flawed things began to change.
You'll have do do some of your own research to be able to advocate for yourself
Check out the YouTube videos I suggested.
https://www.pbs.org/newshour/show/how-a-decades-old-study-gave-hormone-therapy-for-menopause-a-bad-reputation
Wow, Mayblin!
I've been wondering if your 2 year Dexa results were back yet and I was so happy for you (and for all of us who dream of putting off bisphosphonates for as long as possible after anabolic therapy) that your BMD held (and/or improved!) so nicely.
Question: How did you and your endocrinologist choose which month(s) to pull out your left-over Forteo pens and use them? Was it because that's when it's commonly held that serum E2 is highest and steadiest after one starts HRT (i.e., at least 6 months after starting HRT?)?
So grateful for your detailed information and congrats again!
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