@steinbeck would you be open to sharing your T score and/or FRAX score? If it's not severe osteoporosis, HRT could be a very reasonable choice, in my opinion. NTX is a marker of bone resorption, not formation - so if it becomes sufficiently suppressed, bone loss tends to slow down. This may also lead to some increase in bmd over time. What form and dosage of estradiol are you using?

I'm also on bioidentical HRT since finishing Forteo, a bone-building treatment. My CTX - another bone resorption marker - dropped so much that my endo described it as "minimal bone turnover". So for now, HRT alone seems sufficient to maintain my bone mass, which was confirmed by a DXA scan.

Did your endo recommend adding Fosamax to your HRT regimen? What was your recent NTX reading?