BHRT vs PHRT

@squitirogloria
You ask "you are in normal bone territory. Is it just from the BHRT and strontium, or other things as well?"

Well, Bone health is a synergistic action. Lots of moving parts that make up how a healthy body makes bone and keeps it healthy. Pharma drugs try to put a stop or a push to parts of that synergistic action.
Supplements, exercise try to meet the needs of the bodies' synergistic bone actions. To basically up everything that the body needs or supply what the body is not getting and allow the body to react. BHRT especially works in this context to provide the hormones needed for an aging body to mimic a younger body and make bone.

Now....consider...

Strontium citrate is a mix of pulling all the levers of normal bone actions in full, not in part like pharma drugs do. It impacts both osteoclasts and osteoblasts using the bodies' own calcium receptors and something which science believes may be a strontium receptor. So taking strontium gives the body something for which it is already set up to receive.

But here is the difference, strontium citrate users take strontium at a therapeutic level, at a drug level. So although the body knows and uses the strontium similar to calcium, if you use strontium citrate you usually take it at a "drug" similar level.

And yes, BHRT plays a role. My endocrinologist explained it this way: "the estrogen drives the calcium and strontium into the bone". But I know from talking to hundreds of strontium users that strontium citrate can work without BHRT.
Whether strontium at a non therapeutic level combined with BHRT would work, I do not know; it would probably depend on the level of osteoporosis.

We need more research, but that is hard to finance for a supplement.

So yes, bone building using supplements which the body already recognizes involves many moving parts, but using strontium citrate at a therapeutic level seems to be able to act on its own to change bone density and fracture risk. (per all the research which I have seen)
https://www.inspire.com/groups/bone-health-and-osteoporosis/discussion/2020-a-review-of-latest-insights-into-the-mechanism-of-action-by-strontium-/

@squitirogloria
So glad to have met you Gloria.

I reply because I owe a debt to the people who helped start me on the path which I am on. Many strontium citrate users stop participating on sites once they begin strontium . This is because they no longer consider their disease to be a problem, but there are a few of us that continue. PhoneyBoney is one as is BoneLady who has her own great blog called Strontium for bones. https://strontiumforbones.blogspot.com/

Osteoporosis is a disease frequently of aging. We just can't easily overcome the lack of hormones. We joke on Inspire that all of us "always consumed dark leafy greens and put a premium on eating healthy and exercising, ". Funny, but true.

Yes, I have recently had to up my BHRT hormones and oh how much better I feel. I am 73 years old.

Medicine is a great deal about keeping our bodies in a good state of balance…we are all very individual…if you have meds for a few or more conditions, you have to be super careful about the supplements you use and how to use them..the results some have may be great…check out how the supplement you’re considering will interact with your own essential medications…sometimes they can upset things you may not notice, like kidney function…definitely don’t want to mess with good kidney function…and the list goes on…sometimes we think if a little bit helps, why not go for a higher dose ? Just be careful —it is complicated and we are often on our own as many docs don’t help certain things ….

@kfhoz
I can understand concerns over taking any osteoporosis treatment without the research needed to make you feel secure in your decision.

Just some information about concerns which you have raised about strontium citrate.

You say:"research articles say that strontium makes un-adjusted DEXA scans appear to show more calcium than you really have, and hence falsely more bone strength."
To clarify: Research has analyzed dexa machines and finds that strontium skews about 10% denser due to its denser nature; it is not correct that it shows more calcium; it does skew about 10% denser; it does not falsely show more bone strength.
https://pubmed.ncbi.nlm.nih.gov/20699129/
TBS reports, which are not affected by strontium the way dexa is, show strontium bones with good bone quality and in the top group of osteoporosis treatments (see attached bar graph from the research). REMS also shows good bone density and bone quality for strontium patients, are per self reporting. Hopefully, a study will be done in the future. The best report we have so far is one done on TBS. A report which shows strontium in the higher level of bone quality. (see attached bar chart) plus Page 7 in linked below
https://www.panoramaortho.com/wp-content/uploads/2019/03/TBS-Review-JBMR-2014.pdf
The research which you hotlinked is from 2009. Much of that information is useful, but because of its age much of it has been rendered moot because of tests like REMS and interpretation methods like TBS, neither of which were available in 2009. Both of these, REMS and TBS, have laid to rest the old, dexa skew concerns, because they both show good bone quality and bone density for strontium users.
Indeed, I just had a DEXA with TBS which showed good bone quality and normal/good bone density. I have been taking strontium citrate since 2009.

The concern about strontium being present in the bone after treatment is actually a plus. Other osteoporosis drugs, specifically bisphosphonates (like alendronate, risedronate, and zoledronate), remain in the bone for years or even decades after treatment stops. They accumulate in the bone matrix, creating a reservoir that continues to provide anti-fracture benefits for 1-2 years or longer, allowing for a "drug holiday" after 3-5 years of use. Strontium also stays in the bone and creates what one report calls "sacrificial bond formation" that correlate to reduced fracture risk. In other words, strontium seems to work mainly because it changes the physiochemical relationship in bone to allow bone the ability to absorb shock and dissipate instead of break....give instead of break. Section 4.2
https://www.sciencedirect.com/science/article/pii/S2352187220300334
Strontium Citrate holds a unique position in the world of osteoporosis medicine between supplements and osteoporosis drugs. It is virtually side effect free and may be begun easily or ended easily without problems. It can cut the risk of fracture around 41 to 49%; it is found to improve bone quality on the comparable level to Prolia and Forteo without the side effects which those drugs have. (see attached bar chart and above linked research)

Also, there was the amazing research done using biopsies of bones, those of a placebo group and those of strontium users. The biopsies showed good bone density and quality. (See attached photo with the link to the research)

The treatment which we choose for our osteoporosis is a uniquely individual decision. It is not just made up of logic, there is a component of emotion in finding something with which we feel comfortable. I try hard not to downplay anyone's choice of treatment. There are lots of good treatments for osteoporosis, and I frequently point people towards information and people who know more than I do about osteoporosis pharma drugs. I honor and do not demean anyone's choice of treatment. We all have to decide what is best for us and rejoice when that treatment works for any of us.

Strontium Citrate works for me, and I am enormously grateful that I found it.

@nycmusic, great advice. I try to get my eGFR, creatinine, and other kidney numbers tested a couple times a year. They are tests included in the Comp Metabolic panel. My eGFR fluctuates a lot, depending, I think, on if I've eaten that morning, hydration, exercise, etc.

Medicine is a great deal about keeping our bodies in a good state of balance…we are all very individual…if you have meds for a few or more conditions, you have to be super careful about the supplements you use and how to use them..the results some have may be great…check out how the supplement you’re considering will interact with your own essential medications…sometimes they can upset things you may not notice, like kidney function…definitely don’t want to mess with good kidney function…and the list goes on…sometimes we think if a little bit helps, why not go for a higher dose ? Just be careful —it is complicated and we are often on our own as many docs don’t help certain things ….

@kathleen1314, how many mg of strontium would be at a therapeutic level? A lot of strontium brands I see are at about 600mg. Thanks for your insights.

@kathleen1314, I'm 73 also and just started on BHRT transdermal patch and oral prometrium. Can you tell me how long you've been on BHRT? And did it help your DXA numbers? I've just started the "moderate" level of generic Vivelle.

@kathleen1314 Thanks so very much for this information. I'm considering starting strontium and wondering if there will be an interaction with the BHRT transdermal patch estrogen and oral prometrium I just started. I'm guessing not, but I need to research it and see if I can get my endo to answer my questions about this.