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Effects of HRT: Alone, in Combination or Sequencing
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!
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Oh I see. Did the Forteo bring your level down to Osteopenia? I’m at a -3.7, so I need something intense
It’s very hopeful to hear about the benefits of HRT, and your mother’s story with HRT is truly inspiring. May I ask at what age your mother started HRT, the method of delivery, doses, and whether she was on estradiol and micronized progesterone?
I’m 57 and have been on BHRT for about a year now, but I’m still trying to get the doses right. I occasionally wake up at 3 or 4 a.m. due to nighttime hot flashes. From what I’ve heard, once the doses are correct, you should feel much better, but I’m still not quite there yet. I do have a mix of good days and bad days. Thank you for sharing your experience on HRT.
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2 ReactionsMy mother had a hysterectomy, but I don’t remember how old she was when that happened. After the operation, she was put in HRT — a combination of estrogen and progestin. Pills. I’m sorry that I can’t offer more specific information.
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1 ReactionNo, Forteo by itself did not, although I'm confident that Forteo played the key role and that the ensuing HRT helped in the final dash. My bone markers showed that I had a very high turnover during Forteo treatment. The bone formation marker P1Np was still at a high reading of 150 at end of Forteo therapy and into the early months of HRT. I'm yet to see my endo to discuss all this.
Wish you the best in your bone journey!
I confess. I’m confused-
My bone markers showed that I had a very high turnover during Forteo treatment. What turnover?
. The bone formation marker P1Np was still at a high reading of 150 at end of Forteo therapy and into the early months of HRT.
What or where do I find this s?
I'm yet to see my endo to discuss all this.
Hope the endo has some helpful input and plans
@patwerthman my apologies if my reply confused you. Here is an excerpt from a published review article: "Bone turnover includes two processes: resorption (removal of old bone) and formation (laying down of new bone). N-terminal propeptide of type I procollagen (PINP) and C-telopeptide of type I collagen (CTX-I) are markers of bone formation and resorption, respectively, that the International Osteoporosis Foundation and the International Federation of Clinical Chemistry recommend for clinical use. Bone turnover markere (BTM) may help to assess the response to anabolic and antiresorptive therapies, to assess compliance to the treatment, or to indicate possible secondary causes of osteoporosis." Hope this helps.
Not all endos use BTM during therapy although bone markers could be very useful at certain treatment juctures. In my case, they turn out to be very useful in monitoring treatment progress and in determining estrogen dosage. My treatment plan is set now for the foreseeable future unless my bone markers and/or annual dexa scan indicate otherwise.
Thank you, thank you; I am on a mission to explore HRT as a possible solution to my next step..
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1 ReactionHi @mautaylor during the period of exploring HRT as my viable drug option to follow Forteo, I consulted cardiologists regarding my cvd risks and obgyn for breast cancer risks. My endo was on board after I was cleared by them. I hope you get your pathway forward sorted out soon!
Just in case you are searching for more HRT related info, the following links to HRT discussion threads might be helpful:
https://connect.mayoclinic.org/discussion/transdermal-hrt/
https://connect.mayoclinic.org/discussion/hrt-safety/
This following paper is very useful in that it's a compilation of users' data for women older than 65:
https://journals.lww.com/menopausejournal/fulltext/2024/05000/use_of_menopausal_hormone_therapy_beyond_age_65.3.aspx
Table 3 and 4 summarized risk reduction or increase based on:
-Estrogen alone
-Estrogen + progestin
-Estrogen + progesterone
Then sub-categorized by type of estrogen, route and dose.
https://journals.lww.com/menopausejournal/fulltext/2024/05000/use_of_menopausal_hormone_therapy_beyond_age_65.3.aspx
Please note that those are relative (not absolute ) risk reduction/increase in the tables.
@mayblin can you share what your HRT dosage is? I started ~ 3 wks ago on HRT at lowest transdermal estradiol dose and oral progesterone. Diagnosed end Oct with osteoporosis at age 54 (-2.6 lumbar spine is my worst score). But curious how often you had bone markers tested to check for improvement with HRTs.
Hi @hollymarie I'm on transdermal estradiol patch 0.025mg/day (generic for vivelle dot) and oral micronized progesterone 100mg (generic for Prometrium), taken at bedtime. I started HRT right after the conclusion of Forteo treatment. I had my bone markers done at 1mo, 3mo and 6mo. If stable, id probably monitor every 6mo from now on. The high frequency of labs is due to my bone turnover were pretty high during Forteo injection, and I wasn't sure if a low dose of estrogen would be enough. Surprise, CTX had gone down to 167 at 6mo of this low dose! My endo commented "looking good, suggesting against active bone breakdown".
You are at a good age to start HRT. Please keep everyone posted regarding your progress.
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