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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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@annie208, thank you!
Given the choice, I would’ve preferred to wait longer before using those 3 extra pens, but they were expiring in July 2025. As a result, the additional pens were used during months 7–11 of HRT without regard to the response to HRT or serum E2 stabilization.
I began with every other day dosing at my endo’s suggestion and later switched to daily dosing based on my P1NP response. Interestingly, P1NP rose 27–37% even though overall bone turnover remained low: CTX stayed below 135 and P1NP below 35 throughout the 3-pens’ use. My endo was not particularly surprised. She noted that I had completed a full course of Forteo only about 6 months earlier and that I appear to respond quite well to estrogen, so my bone turnover was already in a suppressed state.
My current understanding is that the substantial BMD gains during my first year of HRT likely reflected several overlapping processes: residual effects from the original anabolic course, ongoing mineralization (including secondary mineralization), estrogen-mediated suppression of resorption, and some contribution from the additional teriparatide. Seeing BMD stabilize in the second year without other confounding factors is a considerable relief.
Where are you in your treatment journey?
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1 ReactionIs there anyone here who has started HRT before starting Forteo, or started them at the same time?
Wonderful news!!! Thank you for the post! I am only six months in on Tymlos. I am dreading the what next after the two year mark, as I do not want to go on other meds. I would like to go on bHRT, but so far waiting to get approval as cardiologist is unsure until my progress on statins improves. I read that bisphosphonates are necessary to turn the soft bone growth on Forteo into hard bone. Your TBS shows that is not true. What is most surprising is that your results shows greater gains on HRT than you had on Forteo! Your post is encouraging and hopefully I can follow your lead to great results.
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3 Reactions@erinz
I believe @md79 and @goseve are using both Forteo and HRT at the same time. I’m tagging them here in case either has any updates to share. Otherwise, you can check their profiles and read through their past posts. It would be really interesting to see how bone turnover markers change and how the DXA scans turn out with the combination.
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4 Reactions@summera1
There are several possible explanations for the substantial gains I experienced during the first year of HRT, see https://connect.mayoclinic.org/comment/1694225/.
The main reason may be my strong response to Forteo, with P1NP levels reaching as high as 450 at 13mo and around 150 in the early months after starting HRT.
There was a 3.2% dip in TBS during my 2nd year of HRT as you pointed out, though my report does not provide an LSC for TBS. The 2019 ISCD Official Position recommends that facilities establish their own TBS LSC using the same precision methodology as for BMD, or use a conservative estimate of ~5.8% (the largest LSC reported in the published data). Without a facility specific LSC, it is difficult to determine whether my 3.2% change in TBS exceeds measurement variability.
Same as you, I was on a statin for high LDL-c. One of my cardiologists added ezetimibe to further lower my target to below 55, as she felt more comfortable with that before I started HRT (I had a mild CAC score of 38.) Hopefully you’ll get cardiologist approval soon.
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1 Reaction@mayblin, thank you very much for your response. I knew nothing about
either of these things before joining this forum and am learning so much
now. I really appreciate everyone here sharing their experiences.
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1 ReactionThank you for your questions. Yes, I started HRT and Forteo at the same time on July 15th this year, which means I am currently on my 4th Forteo pen. My DXA scan results were not bad at the time of the spinal fracture: spinal T-score -1.9 and hip T-score -0.6, which was borderline osteoporosis. My latest labs show a highly encouraging response to the Forteo therapy:
• P1NP: Increased significantly to 171.2 ng/mL (up from 42.1 ng/mL at the time of my fracture).
• CTx: Is currently at 440 pg/mL (up from 234 pg/mL).
The data show a strong bone-building state, which gives me confidence that my T11
vertebra is actively healing. My next DXA scan is scheduled for March 2027, which is one year post-fracture and about 9 months since I started Foteo and the estradiol 0.025 mg patch.
I graduated my physical therapy and moved 3 times per week gym. I get most of my calcium from diet and to reach 1200 mg of calcium per day I suplement with NBI Osteo K minis or NBI MK-4. I try to get enough fibers and probiootics through diet. However, I need more protein per day that is very difficult for me to digest.
Hope my information will be helpful for others. I wish a happy journey to stay healthy and strong!
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6 Reactions@md79
That’s such a wonderful anabolic response with the Forteo + HRT combination! Thank you so much for taking the time to share your results. This will no doubt be helpful to others who are considering a similar treatment approach.
Wishing you the very best with your upcoming DXA; I hope it brings even more good news!
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1 ReactionI am 75 and have recently had a DEXA showing severe osteoporosis in right hip at T -3.
I want to start Forteo as it seems to have the least side effects and seems to work but my part d drug plan has a $700 a month co-pay for it until I reach my deductible. I am thinking on starting in January. I would love to hear of people’s experiences on it, Should I be asking my dr to goon HRT even at my age? I need help from people who are already on Forteo. Some of the meds offered for osteoporosis seem to have significant side effects. Thanks for any info you can share
Since it is time to review plans and coverage, will you be researching this to see if another plan may help with cost?
I had no noticeable side effects in my 2 years on forteo. My results were modest but in my case may have been negatively effected because I was on a bisphosphonate first.
Sequencing is very important when it comes to osteoporosis treatment.
Are you seeing an endocrinologist and/or a physician who is up to date on the latest research and has significant training and experience with osteoporosis?
Most of us here find that doing our own research becomes very important in working with our doctors to develop a treatment plan and in advocating for ourselves.
Bhrt/brt can be a help with bones but is not a replacement for meds if there is significant bone loss
Dr. Susan Hardwick-Smith has some great YouTube videos on hormones for older women.
I started at 77. My bones were not the primary reason although I knew it would offer some help