Exactly, you summed it up well! Ideally, your case is best managed via interdisciplinary collaboration, where specialists work together to evaluate the risks of each drug in the context of your specific medical conditions.

I started HRT at 61, 11 years post menopause. The decision is now described as "individualized assessment and shared decision-making process". I wonder if your endo's take on HRT was based on your Tscore and/or FRAX score. In my view, your endo is the one to determine whether HRT is the appropriate agent in managing your osteoporosis, while your cardiologist and obgyn are best suited to assess the potential risks for you.

HRT is generally used as an antiresorptive but is not officially indicated for treatment for severe osteoporosis. It can improve bmd to a certain extent, particularly during the first two years of therapy. So, if you are aiming for significant bmd gains in the near future, your original question still stands, a challenging one, indeed.