Bioidentical hormones for osteoporosis

You didn't mention the MG your current estradiol transdermal patch is. I am also 74 and healthy (according to my blood workups). I take one medication a day, a low dose of 10mg of simvastatin to manage my high cholesterol. My lipid panel and Chol/HDL are all within normal limits. I understand that .05 mg is the lowest "effective" dosage for bioidentical transdermal estrogen for osteopenia/early osteoporosis. The 2000 Women Health initiative used .625 mg ( a synthetic and 12x more than .05) and ran into problems. Transdermal estrogen patches are recommended at an intervention stage for osteopenia and early-stage osteoporosis in "certain" circumstances.
It's been 30 years since I had my partial hysterectomy due to endometriosis. Four years after my hysterectomy I started bioidentical transdermal bioidentical estradiol patches. In 2005 I stopped due to inaccurate news from the Women's Health initiative. If I had the accurate correct information I would have never stopped. After that, I switched to bioidentical vaginal "Estrace" estrogen. When I was 64 (2014) I used a topical systemic bioidentical compounding cream combination of estrogen and testosterone for a year. For the past 10 years, I have only used compounding vaginal estrogen. I have yearly blood hormone lab work-ups done for levels of estrogen. All of my lab results showed a negligible amount of estrogen. None of the "local" vaginal estrogens were systemic.
On 6/21/2022 I had a Dexa scan that showed I had a T score of -2.5 Osteopenic. T score of the left femoral neck is -1.7 and T score of the left hip is -1.4. I live in a state that is 2nd to the last worst state for health care due to a severe shortage of doctors. It has taken me 2 years to find a doctor and then go through long wait times to see one. I have a good endocrinologist now. She says after having a full workup of my health she has no concerns about giving me transdermal bioidentical estrogen to treat osteopenia and early osteoporosis. She started me off at 0.025 estradiol transdermal patch. She said she couldn't start with the .05mg because she needed to get a baseline and start slow. In 3 months hormone lab work will be done ( .025 mg, only trace systemic amounts) She will move me up to the .05 RX. I get my two-year DEXA scan on June 24th. She said it didn't matter what age you started estrogen it depends on your health circumstances, whether you have a uterus or not, have diabetes or prediabetes, heart disease, have had cancer etc. She also said there is no age that you have to stop taking estrogen. The Women Health initiative says using a bioidentical transdermal estrogen patch lower than .625 has not shown any correlation with strokes, cancer, or blood clots.

I am in the process of beginning bioidentical hormones soon. I have been on Tymlos for almost 2 years and will be taken off in June. I have gained 11% bone density in my spine and don’t want to lose my gains. While my rheumatologist wants me on another osteo med, I have researched bioidentical hormones and my cardiologist who is well educated in bioidenticals has suggested beginning them, because my bloodwork shows extremely low hormone levels across the board. He does prescribe creams that are placed on the inner labia…my question would be, will they have a positive effect on my bones? At least keep my gains. He believes they will keep my gains and keep my bones healthy. Any insight? Thanks.

from what I understand, vaginal estrogen cream stays mostly in the localized tissues and is barely systemic so may not have an effect on your bones. An estradiol patch along with oral micronized progesterone would probably be best for maintaining bone density.

Hi @kisu have you ever had your blood estrodial level checked during the period when you had your topical estrogen cream (not vaginal)? If so, did the topical cream give you a meaningful blood level?

What’s your blood estrogen level after you use transdermal 0.025? Or you are still waiting for the lab? Keep us posted please!

Curious, besides a biannual Dexa check up, do you use any of the bone turnover markers to monitor effectiveness of HRT, at least with CTX?

Thanks a lot!

I am in the process of beginning bioidentical hormones soon. I have been on Tymlos for almost 2 years and will be taken off in June. I have gained 11% bone density in my spine and don’t want to lose my gains. While my rheumatologist wants me on another osteo med, I have researched bioidentical hormones and my cardiologist who is well educated in bioidenticals has suggested beginning them, because my bloodwork shows extremely low hormone levels across the board. He does prescribe creams that are placed on the inner labia…my question would be, will they have a positive effect on my bones? At least keep my gains. He believes they will keep my gains and keep my bones healthy. Any insight? Thanks.

My first transdermal 0.025mg blood test will be on June 27th. My doctor said, she only expects this blood test to show a minimal estradiol increase. Part of the plan is not to flood my system with systemic estrogen and let my body adjust slowly. As much as I would like to start the .05 right now it's probably prudent to do it this way since I haven't had significant levels of estrogen for years. In your reply to "Did the topical cream give you a meaningful blood level" When I was using a topical estradiol cream (compounding with some testosterone) my concern was stopping my hot flashes. I did not have any bone loss at this time. So, as far as meaningful levels to support bone I don't know. I have learned that topical systemic estradiol creams are inefficient at providing a steady level of estrogen and transdermal patches are superior. I have not had a CTX. I'm unclear if it's necessary. I will ask my endocrinologist your question on May 1st.
The research shows that .05 mg 2x a week is the lowest transdermal patch dose effective in slowing down bone loss or preserving bone level. Effective estradiol blood serum levels are between 40 and 80 with 50-60 being a good range. Depending on the person you may need a higher dose to get these serum levels. As a side note, the last time I used transdermal patches they didn't stay on very well since I was in the pool a lot and like to take long baths. This time I'm wearing a Max Hold waterproof band-aid over the patch.