Connect
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!
Like
Helpful
HugInterested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.
Connect
In addition the money allocated for women's health issues is miniscule comparatively.
I realized that I did not share this part. I have been on osteoporosis meds for 9 years so the bhrt is secondary. I am getting many other rewards from bhrt!!!!
-
Like -
Helpful -
Hug
1 ReactionAnd will no doubt be less over the next four years.
Yup!!
I'm wondering the effects of testosterone on bones. It will be interesting to compare HRT (estrogen +/- progesterone) with or without testosterone on bone markers and bmd.
-
Like -
Helpful -
Hug
1 ReactionI am interested in this as well. I have been curious as well. I understand that testosterone is is helpful in bone health.
@mayblin…this is such good news. I am 72, had a complete hysterectomy in my late 30’s was on hormones for a short time and ended up with severe osteoporosis. Diagnosed in 2020, I then went on a 2-year protocol of Tymlos in 2022 and had great gains. My rheumatologist wanted me on Evenity to lock in my gains but I chose to try bioidentical hormones which my cardiologist suggested. After his unexpected death I was referred to a very proactive and progressive integrative obstetrician gynecologist who agreed that HRT would help my bones.
I’ve been on them since July and will meet with my obstetrician soon to see if the hormones are maintaining my bones. She has me on an estrogen patch, oral progesterone and a testosterone creme.
Did you go straight from ur Forteo protocol to HRT?
Your info is invaluable. Thanks for sharing. Rose
Hi, @dooshie: Would you mind letting me know what your cardiac issue is that your cardiologist suggested HRT instead of Evenity? I have a left branch bundle block and have variously (depending on the doctor) been diagnosed with cardiomyopathy; basically, my heart doesn't pump efficiently and it's now controlled by a pacemaker. My current cardiologist feels I'm not a heart attack risk and to rule out stroke risk he ordered a carotid study. I don't have results of that yet. But his opinion after googling Evenity was that it wouldn't be risky for me. He said the same about HRT. He has not studied either in depth, mind you, and he seems to be more concerned about the osteoporosis -- that I will break a hip and consequently die -- than he is about my cardiovascular risk.
My endocrinologist, meanwhile, disagrees both about the Evenity and the HRT risk. She has had two patients have a heart attack on Evenity, but they had no known cardiac problems, and as far as I'm concerned, might have been heart attack candidates without the drug. No way to know, right? As far as HRT goes, I am 73, more than 10 years past menopause, and because I've got a heart condition she thinks HRT is "too much risk for too little reward." She wants me to start Prolia and then go on Reclast.
I am VERY disappointed by her point of view, but it's given me enough pause not to trust my cardiologist's, either. So could you tell me why your cardiologist shied away from Evenity but felt HRT would be safe enough for you? It might help me to know given that both have cardiac risks.
Thanks for any words of wisdom... 🙂
@bayhorse hello, my cardiologist was not against me taking Evenity, he was not familiar with OP meds, but he was very educated on HRT. He had done extensive cardiac testing on me when I first started seeing him to get a baseline of any cardiac risks I had. I had had an ablation done in my 30’s for SVT but other than that, I have no heart issues. So, not taking Evenity, as of today is my choice. To be honest, I was on Tymlos for 2 years with good results and very mild side effects, but with Evenity, I have to go into my rheumatologist’s office once a month for an injection and with our travel schedule, that would be difficult. If I could have remained on Tymlos passed the 2-year limit, I would have. I may be making a mistake not taking an OP med, I’m very active and know I may be risking a fracture. My new integrative gynecologist is much in favor of me taking hormones. She also is very educated and progressive. I will be visiting her soon and hope that my bone density is remaining stable. If not, I have a decision to make. Rose 🌹
Hi @dooshie thank you for sharing your experiences and your inquiry. Yes, I went from Forteo directly to HRT (without testosterone). Coincidentally like you, I started HRT last July. Looks like it has held my bmd so far (per Jan 2025 DXA scan) and helped gaining more.
Looking forward to hearing your dexa results. It will be nice to get bone marker labs done to see if they correspond to dexa results.