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Femoral neck -2.8: Would you start treatment now?
From Osteopenia to Osteoporosis in Five Years - what would you do?
Hi everyone, I'm 57 and was recently diagnosed with osteoporosis after progressing from osteopenia over the last five years.
My 2026 DXA results are:
Left femoral neck: T-score -2.8 (osteoporosis)
Right femoral neck: T-score -2.3
Total hips: -1.7 and -1.9
Lumbar spine average: -1.2 (although I'm investigating whether this may be masking more significant bone loss, as L4 alone is -2.2)
My previous scan in 2021 showed a lowest T-score of approximately -1.3, so the drop to -2.8 has been a shock. I went through menopause without HRT, had a demanding job, did very little exercise, and paid little attention to bone health. Although my doctor knew I was menopausal and had osteopenia, I wasn't aware how much bone loss could occur during this period. I have seen my doctor and am being referred to a specialist. MHT/HRT and osteoporosis medications have both been suggested. I am now about five years post-menopause. I don't have menopausal symptoms such as hot flushes, and my main concern is bone health.
My dilemma is deciding whether to:
Start MHT/HRT now and see whether it helps protect bone.
Go directly to osteoporosis medication.
Spend 12 months focusing on exercise, nutrition, calcium, vitamin D, and strength training, then repeat the DXA before making a treatment decision.
I am also concerned about the long-term commitment involved. MHT may be reasonable for five years, but I'm uncertain about the balance of benefits and risks beyond that, and I've read about the potential for bone loss after stopping treatment.
My questions are:
Has anyone started MHT/HRT around five years after menopause primarily for osteoporosis?
Was it worthwhile for your bone density?
Did anyone choose to monitor and focus on lifestyle changes for a year before starting medication?
If you had a T-score similar to mine (-2.8 at the femoral neck), what treatment path did you choose and why?
Looking back, would you make the same decision again?
Thank you. I'm still coming to terms with the diagnosis and would really appreciate hearing about other people's experiences.
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I would not solely spend time on non-medication approaches at this point. Your bone density has gotten worse and will probably continue to do so. The nutrition and exercises are important, but if it were me, I'd want to use meds to get my T-scores back to -2.0 or better.
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1 ReactionIf you're only interested in bone support you might research Menostar.
What is mht? I know hrt and bhrt (bioidentical hrt). If I were you I would begin by going to the search function and try each of those subcategories. There is lots shared here about each. Another great resource is OsteoBoston.
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1 Reaction@gravity3 Thank you. I'm in Australia, so MHT (Menopausal Hormone Therapy) is the term our doctors tend to use now, although it's essentially what many people still call HRT.
I've only recently been diagnosed with osteoporosis, so I'm still trying to understand all the options. I'll search through the previous posts and check out OsteoBoston. I appreciate the recommendation.
@tillymack Thank you, I'll look into Menostar. My main concern is bone health rather than menopausal symptoms, I'll definitely read more about it before I see the specialist. One of my dilemmas is whether to start HRT for bone health or go directly to osteoporosis medication. I'm still trying to work out which path makes the most sense at 57 and five years post-menopause.
@njx58 Thank you. Your response really gets to the core of what I'm wrestling with. Part of me wants to throw everything at lifestyle changes first, but another part of me worries about losing more bone while I wait, and risks associated with HRT.
If you were in my position, which medication would you start with and why? Are there particular treatments that are more likely to move a T-score from the osteoporosis range back into the osteopenia range (around -2.0 or better)? Thank you so much.
That’s a huge drop in scores. Were your scans done on the same machines?
If they were and you’re truly losing bone that quickly then I think the time for lifestyle interventions may be past.
MHT might help slow the bone loss but it will probably not restore lost bone.
I hope that your doctor is also looking for other underlying conditions beyond menopause and loss of estrogen.
For example, I started on HRT during perimenopause and have been on it for 14 years. It did not prevent me from deteriorating into osteoporosis. I’ve been on medication for 8 years and only last year my new endocrinologist discovered that I have hypercalciuria, meaning that I excrete more than three times the normal amount of calcium in my urine. People with hypercalciuria are more prone to osteoporosis.
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