My intention is definitely not to promote HRT over OP medications. I have no investment in promoting HRT. I thought the study you quoted from my Medscape post up top I opened the discussion with, which Gently kindly posted the direct link to study from, might be of interest to those on HRT or considering it. You are extremely well informed about the risks of HRT with your history of breast cancer . With your history I would also be extra cautious, vigilant and scrutinizing of any study or "expert" opinions as you should be. We all need to be extremely cautious and informed about our health conditions and any treatments we consider. I have regrettably been terrified of HRT since menopause due to the WHI study and with no history of breast cancer wish so much now I had looked into it sooner.

With your knowledge and health history, you look at HRT studies and presentations with a more informed and critical eye which benefits us all. I thought Dr. Gersh presented some valid and helpful information but did also wonder about breast cancers not yet detected "hijacking the estrogen" as she explained. Dr. Gersh also doesn't go into specific treatment methods and doses, as the Menopause study does, such as transdermal vs oral and so on.

I received my advanced OP diagnosis 6 months ago. At this time I am still in the decision making process and investigating all my options. At age 67, I am looking at a long term lifetime plan I can live with weighing the benefits and risks, side effects and quality of life. I have a history of severe medication side effects prescribed for other diagnoses with some causing permanent damage. OP drugs can also pose serious health risks such as heart issues, stroke, future fracture... so I am willing to look at HRT to possibly stop progression, though well aware it will not build bone. I am not under any illusion I will never fracture because I haven't yet and still feel fine as this disease is a silent killer. Reading about fracture experiences from people like you is invaluable information and so appreciated.

As Keith McCormick says, the BMD score is only part of the picture. Bone quality is equally important. He says bone quality can improve a lot before BMD scores improve. My fragility bone quality score on the REMS Echolight gives me some comfort as it puts me still close to good quality zone amazingly with my REMS spine T score at -3. The combination of my REMS bone quality score and REMS T score reduces my fracture risk considerably compared to my FRAX score based only on the DXA . The DXA scored me at -3.5 but DXA alone doesn't measure bone quality. Dr. Kim Zambito, Orthopedic surgeon, explains the REMS report much better than I can: https://www.youtube.com/watch?v=v0tclg8LYAo

Bone quality measurement can go the other way as well. Someone with a fairly good BMD T score can have poor bone quality putting them at high risk for a fracture they are unaware of with misleading BMD scores. A TBS is another method for measuring bone quality which I hope to obtain. My hope is that if I can maintain my present bone quality and halt the progression of bone loss on my next DXA in November, I may be able to avoid OP medication. However, I am a realist and will consider future medication if I continue to lose BMD.