Connect
← Return to Looking ahead after Tymlos: Reclast, Evenity or HRT?
Discussion
Looking ahead after Tymlos: Reclast, Evenity or HRT?
Osteoporosis & Bone Health | Last Active: Mar 30 12:08pm | Replies (72)Comment receiving replies
@mayblin Thanks so much for reaching out! My original post was last May 2024. I'm now about to start month 15 of Tymlos. I have seen 2 more endos since last May. In Sep the endo I saw just encouraged me to stay the course and was proposing bisphosphonates after I'm done with Tymlos. Hard no to HRT because of all the negative side effects associated with them....despite those being repeatedly refuted by current research. Plus I'm well more than 10 years past menopause. More like 20. No dexa at that visit, but my blood calcium levels were 11.1 and cholesterol had also risen again. Both of those levels were never out of whack until Tymlos.
In Jan 2025 I saw another endo at a the University of Iowa, about an hour from home, who only sees osteoporosis patients. She is supposed to be the "guru" of all things osteo. Same story with her. Stay the course and recommended Prolia after year 2 of Tymlos. I did have a dexa scan this visit and my Lumbar score improved from -3.6 to -3.2 from my first dexa in 2023. No hip score or cervical score because she "doesn't do those as they really don't matter." Also the calcium score was down some to a 10.6. Cholesterol was at a mind blowing 280. Another hard no to HRT or even considering it, same reasoning. This time I pushed back a little and asked about bioidentical HRT and also asked about her thoughts on the current research discounting all the bad press around HRT from a faulty study. She said exactly this, "No, no. It makes no difference what or where the estrogen in the HRT is made. Everyone's body reacts to estrogen the same. It is all processed the same way."
I was crushed....and disappointed that the supposed guru was so very set in her thinking. I'm not going to take Prolia. That is my hard no to the next step after Tymlos. I'm now trying to find a cardiologist to check out why my cholesterol is so elevated, getting a screening for arteries to see if there really is any blockage. If there is any that may prevent anyone from prescribing HRT. Then trying to find a doc who will prescribe is nearly impossible here. I live in a rural area where health care from functional, integrative and naturopaths are hard to find. Also on the search again for yet another endo. I do have a rheumatologist who is a hard no on HRT because her mother took it and ended up with breast cancer. No reason to push her on the subject as she has personal reasons for opposing.
The quest continues. I still have a handful of months left and I may just give myself a drug holiday of my own if I keep running into "hard no" answers! Take care,
Nonna
Replies to "@mayblin Thanks so much for reaching out! My original post was last May 2024. I'm now..."
Connect
I found that the approaches to HRT differ quite a bit between your endos and mine. Mine determined HRT is a viable tool in my op management however she left the risk assessments to other physicians (obgyns and cardiologists). Yours determined risks > benefits in your case (without consulting obgyn and cardiologists?). I wonder if their opinions were based on "time hypothesis", which favors starting HRT within 5-6 years after menopause, or at least within 10 yrs post menopause with consideration of cvd risks as a general practice.
Here are a few videos in which menopause specialists (obgyns) talked about when is too late to start HRT:
Seems to me the risk assessments are individual based for those who are post-menopausal more than 10yrs. One physician in the video grouped post menopausal women into 3 groups: within 10yr, 10-20yr and greater than 20 yr post-menopause, she then generalized some risk characteristics for each of these 3 groups.
I'd imagine there is a sizable ob-gyn dept at University of Iowa hospital system, and there may be physicians who specialize in menopause/hormone replacement therapy if luck is on your side. You'd definitely want to hear what obgyn/cardiologist has to say about you risk(s) in using HRT and then circle back to endo(s) to discuss again with the risk assessments from other physicians.
Without an antiresorptive following Tymlos, most people will lose bmd gains gradually within 1-2 years. There was a clinical study done on Forteo cessation which showed most lost bmd gains after 2 years if not follwed up with an antiresorptive. Women lost at a faster rate than men did. If you feel strongly about HRT but don't have enough time to get risk assessments done, you could discuss with your endo the feasibility of taking a 'gentler' bisphosphonate such as risedronate (brand name: actonel or altevia, the latter is delayed release form) or even alendronate for a short period of time then transition to HRT afterwards. If HRT not feasible, then either alendronate or iv reclast is the most probable path. It is very interesting to follow tymlos with prolia. I wonder the rational behind this choice and if this endo had a limited treatment term in mind (to be followed by a bisphosphonate).