@oitsu62 I was reviewing McCormick's book last night and again, he expresses the idea that HRT might maintain density but most likely won't increase it. I think fear drives a lot of decisions. For obvious reasons (cancer) I am way more afraid of HRT than Tymlos (especially since the dose of Tymlos can be played with). But what your post leaves out if the fear of fracture. I was way way more afraid of more fractures than Tymlos.

The hard part about osteoporosis, which I think sometimes increases our risk, is that it does not have symptoms. We feel fine, even strong. Fractures are not only painful but affect lungs, GI function, and ability to do things for oneself. They don't just happen from falls.

I am not sure why taking HRT after menopause ( a natural event) is more "natural" than using another kind of hormone, the parathyroid, to grow bone. People say strontium is "natural" but the therapeutic dose is 300 times the daily requirement, I just read.

Tymlos works- at least for many of us, and you can do bone marker tests to make sure it is working for you. You can start at 1/4 dose and move up. My spine went from -3.7 (severe) to -2.5 (borderline) and continues to improve.

If your DEXA's are better than -3.0 and your FRAX score is low, it is very reasonable to try HRT, diet and exercise so I am only posting for those with serious osteoporosis.