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Effects of HRT: Alone, in Combination or Sequencing
Have you used HRT as the sole modality for osteopenia or osteoporosis? How about using it in a therapy sequence or in combination with another osteodrug, either an anabolic or an antiresorptive? What is the outcome of such choice(s)?
After a diagnosis of osteoporosis nearly 3 years ago, I elected Forteo as my first drug therapy then transitioned to HRT afterwards. Forteo gave me a jump start on building bones: lumbar bmd +8.6%, hips r/l +4.8/2.2%, femur necks r/l +8.9/3.4%. Bmd improvements are as follows after 22mo Forteo followed by 6mo HRT (scans were done with same machine and by same tech):
Lumbar spine bmd +18%, T score from -3.4 to -2.3;
Right hip bmd +9%, T score from -2.3 to -1.8;
Left hip bmd +4.1%, T score from -2.1 to -1.8;
Right femur neck bmd +16%, T score from -2.4 to -1.6;
Left femur neck bmd +9.8%, T score from -2.5 to -2.0;
TBS from 1.264 to 1.322
So far so good but I know this is just the start of a long road ahead.
I’m very grateful for the existence of Mayo Clinic Connect. Without this forum I’d never thought HRT would be in the cards as I’m more than 10 years past menopause. Many thanks to @vkmov for initiating the thread “Transdermal HRT”, @teb for her generous sharing of personal experiences, and countless members for their in depth discussions and suggestions.
The inclusion of HRT in the management of osteoporosis isn’t mainstream, in fact it is not approved for the treatment of osteoporosis so data and evidence are lacking. It will be helpful if we could share the outcomes of HRT among those of us who have chosen to use HRT under the care of our team of physicians. Dexa results possibly with bone turnover markers and/or TBS info if available will be nice. By the way, my CTX trended down to 163 after 6mo HRT from a high of 793 at end of Forteo treatment, a change I didn’t anticipate at all.
Any comments or analysis are welcome; and best luck to us all no matter what therapy path(s) we choose!
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Thank you, this is good to know!
@sonodeka thank you very much for this information! This could be handy for someone if needed. I read a little more about this topic. Here is a link that provided a list of patches (not complete) that are matrix-based, and could be cut. They provided a link for consumers to double check also:
https://www.medicinesinformation.co.nz/bulletins/can-transdermal-patches-be-halved/
It looks like the common generic estradiol patches made by Mylan or Sandoz are matrix-based. The Brand Vivelle Dot (was popular) is not.
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4 ReactionsHi mayblin! Thanks for doing the legwork on my post! That's a very helpful link. I was luckily able to get a quick prescription change when I needed to lower my estrogen dose before a long trip and was uncertain about cutting down my generic sandoz patch. I was new to my patch at the time, and could have saved some stress!
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4 ReactionsTWO ALTERNATIVE METHODS FOR HALVING THE RELEASE RATE OF RESERVOIR PATCHES (BUT CAN ALSO BE USED FOR MATRIX PATCHES):
Fold the patch in half with the non-adhesive sides together and apply the adhesive part to the skin. Secure the patch with tape. OR
Apply an occlusive (waterproof) dressing on the skin or on half of the patch and apply the patch so that only half of it is in contact with the skin.
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5 ReactionsSo far I have received a firm no but thanks to you, I am printing and sending off to the doctor. I really appreciate you taking the time to reply. I am desperately seeking a follow up regime after two years of Temlos and this forum has helped me understand the options I was considering could be a bit frightening.. Thank you again!!
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1 Reactionloving my BHRT!
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2 ReactionsDear Mayblin,
RE Starting Dosage of HRT for women after 15 years menopause
I know this post is over a year old, but I an inquirying what dose HRT/estradoil progestrone) you started with?
You received incredible reduction in CTX in six months ( 163 after 6mo HRT from a high of 793 ).
I will just be starting HRT at 71 after 4 years of anabolic treatment and nonresponse to evenity with conintued fracture. Good health to yoy
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1 Reaction@dmshope
I’ve been using transdermal estradiol 0.025mg/day patches and oral micronized progesterone 100mg daily at bedtime.
My endocrinologist and a bone specialist originally advised titrating up to the standard 0.05mg/day patch dose (roughly the equivalent of the CEE dose used in the WHI study). However, when they saw my CTX drop to 302 after just 3mo, they had me hold at the lower dose. By 6mo mark, my labs confirmed that the 0.025mg/day was adequate for suppression. Please note that my 1st year BTMs were influenced by coming off Forteo, with a high turnover rate at the time; therefore, part of those initial CTX changes was likely due to that transition.
I’m nearing the end of my second year on HRT, and my CTX has consistently remained below 120 during second year. I won’t have my next DXA results until later this year to see the formal BMD impact.
Have you finished your Evenity course? If so, you may want to keep an eye on your CTX closely as it can take 6-9mos for estrogen to reach its peak anti-resorptive effect, if you choose HRT route.
There is evidence suggesting that low-dose and conventional-dose patches can be equally effective at preventing bone loss across all post-menopausal ages:
https://pubmed.ncbi.nlm.nih.gov/8706298/
I believe @debbie1956 used the same dosing as mine and I’ll tag her here. I’ll also tag @teb who has been on HRT for quite a long time and shared similar experiences in the past, just in case either of them has a moment to chime in with their experiences.
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2 Reactions@mayblin
Thank you for the detailed and kind response. That gives me guidelines.
I went off Evenity at 11 months due to no reponse ( no dexa improvement) and continued fracture ( lower limb). It may not have been the evenity as much as the sequencing of evenity so close to tymlos and after a course of actonel. Evenity after tymlos has lower effectiveness but still should have some effectiveness.
I am hoping the HRT will improve cortical bone and nourish my body and manage normalizing CTX but as we know CTX increases with a fracture to promote healing; so we will have to moniter this and figure out what is best.
Good health to you.
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3 Reactions@mayblin , Yes, I recall you starting the estradiol patch and micronized progesterone around the same time that I did, approaching 2 years ago at age 67, and that we were on the same doses. My response has been very similar to yours. To CTX tests since starting show that the CTX has come down from 688 to close to 100 within a year. This is a phenomenal reduction as I have never taken anti-resorptive nor anabolic osteoporosis medication. My t-score spine bmd went from -.3 to -2.6. I am due for another bone scan soon as well to see if these gains have held or maybe further improved. When I began HRT, my greatest hope was to stop my staggering progression of bone loss, so this gain was an unexpected bonus.
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