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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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@agag - I did not have any breaks, osteoporosis was a chance finding for me. I was initially offered Reclast by my doctor which would have been a mistake given my poor T-Scores in the spine -3.2 and the femoral neck -2.9. The spine reacts better to medications than the femoral neck, which is very difficult to improve. I did some research to determine an osteoanabolic would be a better way to start treatment. If you start with a anti-resorptive like Reclast, Fosamax or Prolia, the osteoanabolics like Evenity, Tymlos and Forteo have a tougher time improving your bone structure and are less effective. So the order matters.
The good news for you is that the rest of your scan sites are not too bad and I would guess your odds of fracture are pretty low, especially if you don't fall on your hip.
After finding out I had osteoporosis and being a technical trainer, I put together a training for new patients and have been updating it for 3 years now. I do a stupid amount or research and I wanted to share what I've learned. If you have the time, it might be helpful for you.
Please note that I am not a licensed medical professional, and the information presented in the video is for general educational purposes only. The content is shared based on my research and understanding as a patient living with osteoporosis. It is essential to consult a qualified healthcare provider for personal medical advice.
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2 Reactions@agag I am 71 and I started on HRT 18 months ago. I had osteoporosis Lowest was-2.6 femeral neck. I have been going to the gym lifting weights, impact training, balance training. Improved my diet. My lowest score on my May 2026 DEXA was -2.1. I don't know if HRT helped but it didn't hurt. I wish I started when I was younger. The younger you are the more it helps the bones.
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5 Reactions@ipg started HRT 10 years after menopause. Increased my bone by 5% in one year. No longer osteoporosis. Before you take the bone drugs, study up on them. They have serious side effects.
@dvargo
That is great.
@dvargo
I understand completely. However at 71 I don’t believe a dr will give it to me. How old are you?
@ipg 67. Yes a Functional doctor will because there are MANY benefits beside bone health. I plan on taking testosterone, progesterone and estradiol until I see Jesus.
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3 Reactions@ipg
I was 77 when I started bhrt. I went through early menopause at 38.
I used functional medicine. Good luck. A number of women here and in general have started later in life now that the women's health initiative study has been seen as flawed
@dvargo
Yup. I won't go back!!!
My femoral reading is presently -2.6. My spine is osteopenia. I am at present taking a drug holiday and if I could take HRT that is what I would do as there are added benefits in addition to bone health. In your situation, I would spend all my effort on evaluating the appropriateness of HRT for my situation AND focusing on targeted diet and exercise. Especially jumping. Treating hips with various osteo meds is, in any event, notoriously difficult....treating spinal osteroporosis with various osteo meds is usually much more successful. Good luck.
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4 Reactions@gravity3
I am not familiar with the study. Do you have a link to that? Thanks