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Osteoporosis after broken ankle
Osteoporosis & Bone Health | Last Active: Jun 29, 2025 | Replies (14)Comment receiving replies
Thanks Mayblin. It is reassuring to hear that you were able to maintain and possibly gain bmd with HRT, and I appreciate your help with the dosing. Do you have any thoughts about the breast cancer issue? I know it is lower than originally thought. I saw a study in the Lancet from 2019 that stated the risk after 5 years was an extra 14 to 20 cases per 1,000 women. (The forum prevented me from posting a link.) I know all medications have risks. I just had never planned to use HRT until last week.
And thanks for pointing out that the CTX and P1NP might not be accurate for me right now. I have not researched those tests yet, and I would not have thought of that. I want to test for celiac disease soon just to make sure that is not causing this issue.
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You're likely referring to this article from The Lancet:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/fulltext
As you pointed out, the conclusion from this meta-analysis showed a higher estimated risk of breast cancer compared to some other publications. However, the analysis was based on pooled data across all types of menopausal hormone therapy (MHT), with synthetic progestin -specifically medroxyprogesterone acetate (MPA) - making up thr majority of the data set, likely skewing thr risk estimate upwards.
The current preferred HRT/MHT regimen among obgyn is transdermal estradiol, combined with oral or vaginal micronized progesterone for those with a uterus. However, studies or meta-analysis focused on this regimen are very limited.
According to this review paper https://pubmed.ncbi.nlm.nih.gov/29384406/ , " estrogens combined with oral (approved) or vaginal (off-label use) micronized progesterone do not increase breast cancer risk for up to 5 years of treatment duration". When used for more than 5yrs, etimates of the absolute risk (for transdermal E2) might rise by 0.5-1% over 10 years compared to non-users, but is not statistically significant in most studies.
https://journals.lww.com/menopausejournal/fulltext/2024/05000/use_of_menopausal_hormone_therapy_beyond_age_65.3.aspx : this paper, based on very large prescription database, includes an interesting breakdown of health outcomes - such as breast cancer - by hrt type, route and dosage. While you are not in the same age cohort, I thought it's worthwhile to take a look.