1. < Osteoporosis & Bone Health

Effects of HRT: Alone, in Combination or Sequencing

Posted by mayblin @mayblin, 5 days ago

Have you used HRT as the sole modality for osteopenia or osteoporosis? How about using it in a therapy sequence or in combination with another osteodrug, either an anabolic or an antiresorptive? What is the outcome of such choice(s)?

After a diagnosis of osteoporosis nearly 3 years ago, I elected Forteo as my first drug therapy then transitioned to HRT afterwards. Forteo gave me a jump start on building bones: lumbar bmd +8.6%, hips r/l +4.8/2.2%, femur necks r/l +8.9/3.4%. Bmd improvements are as follows after 22mo Forteo followed by 6mo HRT (scans were done with same machine and by same tech):

Lumbar spine bmd +18%, T score from -3.4 to -2.3;
Right hip bmd +9%, T score from -2.3 to -1.8;
Left hip bmd +4.1%, T score from -2.1 to -1.8;
Right femur neck bmd +16%, T score from -2.4 to -1.6;
Left femur neck bmd +9.8%, T score from -2.5 to -2.0;
TBS from 1.264 to 1.322

So far so good but I know this is just the start of a long road ahead.

I’m very grateful for the existence of Mayo Clinic Connect. Without this forum I’d never thought HRT would be in the cards as I’m more than 10 years past menopause. Many thanks to @vkmov for initiating the thread “Transdermal HRT”, @teb for her generous sharing of personal experiences, and countless members for their in depth discussions and suggestions.

The inclusion of HRT in the management of osteoporosis isn’t mainstream, in fact it is not approved for the treatment of osteoporosis so data and evidence are lacking. It will be helpful if we could share the outcomes of HRT among those of us who have chosen to use HRT under the care of our team of physicians. Dexa results possibly with bone turnover markers and/or TBS info if available will be nice. By the way, my CTX trended down to 163 after 6mo HRT from a high of 793 at end of Forteo treatment, a change I didn’t anticipate at all.

Any comments or analysis are welcome; and best luck to us all no matter what therapy path(s) we choose!

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

teb | @teb | 5 days ago

Thanks for the mention. I'm happy to share my experience as we're all in this troubling situation together!

Those are incredibly impressive results! Congrats! Wondering what your next steps will be. Just a continuation of HRT? Please keep us posted. It's great that you are continuing to share as others may find your experience helpful in determining their own paths forward. I'm several months off getting my next dexa but will report back on my results.

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1 reply
gravity3 | @gravity3 | 5 days ago

Thank you for sharing your journey with her. I am walking the same path. If I understand correctly it is common practice I parts of Europe to use hrt/bhrt as a first strategy. I am looking for more information/research.

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oopsiedaisy | @oopsiedaisy | 4 days ago

Your results are very encouraging.

I’m currently on teriparatide after taking alendronate for 5+ years and fracturing T8 while on it. I’ve been on HRT for 13 years.

It’s only recently that I realized I need a long term plan of what to do after teriparatide. I am 63 and still working full time and I would like to be able enjoy an active retirement. I hid my head in the sand for many years about my osteoporosis.

Thanks for sharing your results and wishing you continued success.

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1 reply
psmnonna | @psmnonna | 4 days ago

@mayblin
Congrats on your amazing results! I had similar scores in my Lumbar spine (-3.6) and hip (-1.6) in Jan 2023. I was shocked as my lifestyle contraindicated any thoughts of bone loss. However age, time since menopause (18 yrs) and my personal biology had other ideas. I delayed starting anything until Jan of 2024 while I researched any alternative other than pharmaceuticals..... then I chose Tymlos. It seems Tymlos, Forteo and Evenity were the only way to build bone, as exercise, weight lifting, and diet did not prevent bone loss for me. I've never taken HRT as I'm in the generation who was steered away from it based on the now outdated and flawed study from the early 2000's. I'm anxiously awaiting my next Dexa scan which will be next week. Also seeing a new endocrinologist at that time with hopes of starting HRT. I have no idea what her opinion of HRT is yet, but am hopeful. My current PCP, rheumatologist and 2 previous endos were not in favor. There is so much positive research to support HRT now that I'm not sure why it is still outside the mainstream for osteoporosis treatment. You would think that loss of hormones during perimenopause and menopause, directly related to bone loss over time, would be a first course of ONGOING research and study. Not outside the mainstream.

I agree with you that this forum has been an invaluable resource of support and information. Without it I would never have learned about almost everything I now know to question my drs about. I hope you see continued improvement and progress in your journey and look forward to seeing your results over time.

Good results to us all no matter what path is choosen!!!!

REPLY
2 replies
mayblin | @mayblin | 4 days ago
In reply to @teb "Thanks for the mention. I'm happy to share my experience as we're all in this troubling..." + (show)
@teb

Thanks for the mention. I'm happy to share my experience as we're all in this troubling situation together!

Those are incredibly impressive results! Congrats! Wondering what your next steps will be. Just a continuation of HRT? Please keep us posted. It's great that you are continuing to share as others may find your experience helpful in determining their own paths forward. I'm several months off getting my next dexa but will report back on my results.

Jump to this post

Thanks a lot. I will continue using HRT with periodic monitoring of bone markers and yearly DXA scan, with a plan of retreatment with Forteo in the future when needed.

Looking forward to hearing your results!

REPLY
mayblin | @mayblin | 4 days ago
In reply to @oopsiedaisy "Your results are very encouraging. I’m currently on teriparatide after taking alendronate for 5+ years and..." + (show)
@oopsiedaisy

Your results are very encouraging.

I’m currently on teriparatide after taking alendronate for 5+ years and fracturing T8 while on it. I’ve been on HRT for 13 years.

It’s only recently that I realized I need a long term plan of what to do after teriparatide. I am 63 and still working full time and I would like to be able enjoy an active retirement. I hid my head in the sand for many years about my osteoporosis.

Thanks for sharing your results and wishing you continued success.

Jump to this post

Thanks @oopsiedaisy . Curious, how did your dexa hold up during the period when you used HRT alone? Did you continue HRT while on alendronate and teriparatide?

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1 reply
gravity3 | @gravity3 | 4 days ago
In reply to @psmnonna "@mayblin Congrats on your amazing results! I had similar scores in my Lumbar spine (-3.6) and..." + (show)
@psmnonna

@mayblin
Congrats on your amazing results! I had similar scores in my Lumbar spine (-3.6) and hip (-1.6) in Jan 2023. I was shocked as my lifestyle contraindicated any thoughts of bone loss. However age, time since menopause (18 yrs) and my personal biology had other ideas. I delayed starting anything until Jan of 2024 while I researched any alternative other than pharmaceuticals..... then I chose Tymlos. It seems Tymlos, Forteo and Evenity were the only way to build bone, as exercise, weight lifting, and diet did not prevent bone loss for me. I've never taken HRT as I'm in the generation who was steered away from it based on the now outdated and flawed study from the early 2000's. I'm anxiously awaiting my next Dexa scan which will be next week. Also seeing a new endocrinologist at that time with hopes of starting HRT. I have no idea what her opinion of HRT is yet, but am hopeful. My current PCP, rheumatologist and 2 previous endos were not in favor. There is so much positive research to support HRT now that I'm not sure why it is still outside the mainstream for osteoporosis treatment. You would think that loss of hormones during perimenopause and menopause, directly related to bone loss over time, would be a first course of ONGOING research and study. Not outside the mainstream.

I agree with you that this forum has been an invaluable resource of support and information. Without it I would never have learned about almost everything I now know to question my drs about. I hope you see continued improvement and progress in your journey and look forward to seeing your results over time.

Good results to us all no matter what path is choosen!!!!

Jump to this post

I finally decided to get a functional medicine provider because I was meeting resistance from doctors who are working in big medical systems. I am delighted to be on bhrt and reaping the rewards at76.

REPLY
3 replies
goseve | @goseve | 3 days ago
In reply to @gravity3 "I finally decided to get a functional medicine provider because I was meeting resistance from doctors..." + (show)
@gravity3

I finally decided to get a functional medicine provider because I was meeting resistance from doctors who are working in big medical systems. I am delighted to be on bhrt and reaping the rewards at76.

Jump to this post

Hi Gravity3. I am a 66 yr old woman with severe osteoporosis. My T-score of my hip was -3.2. I am very concerned about taking Fosamax due to thr risk of ONJ and losing teeth. I am interested in Transdermal HRT but my PCP is against it. I read that you met a functional medicine provider. I don't know of any here in McKinney, TX. Do you know if a y other Dr that would consider HRT? I've met with 2 endocrinologist and they also were against it. Thanks for any help or suggestions.

REPLY
2 replies
teb | @teb | 3 days ago
In reply to @goseve "Hi Gravity3. I am a 66 yr old woman with severe osteoporosis. My T-score of my..." + (show)
@goseve

Hi Gravity3. I am a 66 yr old woman with severe osteoporosis. My T-score of my hip was -3.2. I am very concerned about taking Fosamax due to thr risk of ONJ and losing teeth. I am interested in Transdermal HRT but my PCP is against it. I read that you met a functional medicine provider. I don't know of any here in McKinney, TX. Do you know if a y other Dr that would consider HRT? I've met with 2 endocrinologist and they also were against it. Thanks for any help or suggestions.

Jump to this post

@goseve, you might try looking through the database of practitioners listed at the Menopause Society. These doctors generally have knowledge of HRT. Best of luck to you!
https://portal.menopause.org/NAMS/NAMS/Directory/Menopause-Practitioner.aspx

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1 reply
gravity3 | @gravity3 | 3 days ago
In reply to @goseve "Hi Gravity3. I am a 66 yr old woman with severe osteoporosis. My T-score of my..." + (show)
@goseve

Hi Gravity3. I am a 66 yr old woman with severe osteoporosis. My T-score of my hip was -3.2. I am very concerned about taking Fosamax due to thr risk of ONJ and losing teeth. I am interested in Transdermal HRT but my PCP is against it. I read that you met a functional medicine provider. I don't know of any here in McKinney, TX. Do you know if a y other Dr that would consider HRT? I've met with 2 endocrinologist and they also were against it. Thanks for any help or suggestions.

Jump to this post

What is their rationale for not considering it? Are they basing it on your
medical history? Are they basing it on the flawed women's health initiative
study? Have they read any of the latest findings and writings on
bioidentical hormone replacement therapy? In essence what are they using to
make their recommendations?

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