I see. Below is a chart for the percentage changes of P1NP and CTX during 12 month romosozumab (Evenity) treatment, data from its phase 3 study. It looks like the best time to see bone formation marker P1NP surge is during first two months, you might have missed it due to timing, although a concurrent HRT might affect bone markers response.

Curious, has your prescribing physician for HRT discussed various dosage forms for estradiol? Many obgyn prefers transdermal form nowadays due to the benefits of lower risk of blood clots (by bypassing liver’s first passing metabolism) and a more stable hormone level, among others. You might want to ask. From what I read, 1mg oral tablet is approximately equivalent to 0.05mg/day transdermal patches of estradiol.