@psmnonna
First of all, congratulations on your amazing improvement! I'm truly happy for you.

It's really interesting that our starting Tscore were so similar and that we've both ended up in a similar range. From what you shared, you reached a lumbar Tscore of -2.5 after two years in Tymlos, with the last 6mo combined with HRT. In comparison, mt lumbar Tscore improved to -2.9 after 22mo on Forteo alone, and then to -2.3 after 6mo of HRT alone. My bmd gains with Forteo were modest at first, but there was a noticeable jump during the 6mo of HRT alone. This was explained to me by an endo who is familiar with btms and HRT that my high bone turnover state while on Forteo (even at the end of treatment) may have helped extend the anabolic window. I also wonder if adding HRT toward the end of your Tymlos helped continue the bone-building effect. I do wish you had bone markers tracked along the way - it would've been fascinating to see how they changed over time and what insight they might offer.

Since my table may look a bit busy, here's a short version of my sequence: 22mo of Forteo alone -> 6mo of HRT alone -> 5mo HRT plus a small overlap with Forteo (3 pens, various dosing regimen) -> HRT alone afterwards. So my last DXA wasn't purely HRT data because it still reflected that brief overlap with Forteo. The next scan will be the first one showing HRT alone, which should give a much clearer picture of whether bmd is being maintained. So far, my bone markers have been reassuring - my CTX has remained quite suppressed at low 100s on HRT alone.

Like you, I don't have a bone marker baseline. You might consider asking your doctor to order labs, or even self-order online, just to see where your CTX is at now, and especially on HRT alone in the near future. This could reassure you that your bone turnover is adequately suppressed during the antiresorptive phase on HRT alone, which will support the case that you don't necessarily need to switch to or add a bisphosphonate.

It is said that estrogen is a stronger antiresorptive than raloxifene, so it should be effective, though individual response and dosing can vary. We share the same thought that estrogen can be a more natural antiresorptive option, provided the benefits outweigh the risks. Since its effects are readily reversible, it won't "lock" bone turnover into a long term suppressed state the way some other agents might. That flexibility, especially if repeated anabolic treatment is ever needed in the future, feels like a meaningful advantage.

If you decide to check btm, you could test CTX (with or without P1NP) at 1 and 3mo after being on HRT alone. If one test is preferred, around 2mo in might be reasonable since you've already been on HRT for 6mo.

I'm really encouraged by your great news. Let's keep comparing notes as we go.