Femoral neck -2.8: Would you start treatment now?

Posted by agag @agag, Jun 18 8:48am

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.

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

gravity3 | @gravity3 | Jun 21 1:30pm

In reply to @ipg "@gravity3 I am not familiar with the study. Do you have a link to that? Thanks" + (show)

@ipg
https://www.uclahealth.org/news/article/2002-hrt-study-comes-under-criticism

laren3 | @laren3 | Jun 22 5:20pm

In reply to @ipg "@dvargo I understand completely. However at 71 I don’t believe a dr will give it to..." + (show)

@ipg maybe inquire with a functional med doc

Laraine | @lr | Jun 23 6:35pm

I just started on Evenity. My T scores are L--T - 2.9 nd R, 2.3. Have had three insufficiency fractures in less than a year--last summer (left foot) and this year (Saccrum).

My first infusion of Evenity was two days ago, one in each of my upper arms. Felt a little weird the rest of the day, and yesterday and today, felt fine though i am having a few more headaches.

The current plan is 11 more infusions of Evenit then another drug, Reclast. I'm 79.

njx58 | @njx58 | Jun 23 7:36pm

In reply to @lr "I just started on Evenity. My T scores are L--T - 2.9 nd R, 2.3. Have..." + (show)

@lr It doesn't need to be Reclast (a powerful infusion.) It could be a Fosamax pill. That's a discussion for later.

Laraine | @lr | Jun 23 9:37pm

In reply to @njx58 "@lr It doesn't need to be Reclast (a powerful infusion.) It could be a Fosamax pill...." + (show)

@njx58 Thanks for your input. Eight years ago I started Fosamzix via a weekly pill. I was sick after 4 days. I took a second pill and immediately became sicker than the week before--severe headache and aches and pains all over. Couldn't leave a dark room. Bummer as I know my osteopenia had been getting worse. This time I was told no pills--needed to go direct which is supposed to minimize the side effects I had from Fosamax. I was told that even though I took Fosamax, it was only two times and should not affect Evenity's positive effects. There are other options beside Reclast I have been told. You are right. Will explore later. Thanks again.

agag | @agag | Jun 24 5:07am

In reply to @oopsiedaisy "@strongbonez I was on Fosamax for just over five years. I had reasonable gains for the..." + (show)

@oopsiedaisy Thank you for sharing your story. You've had quite a journey, and I'm glad you finally found an endocrinologist you trust. One thing that really stands out to me is that the hypercalciuria wasn't discovered until much later. A few people have now mentioned secondary causes of osteoporosis, and I will be asking about additional testing before deciding on a treatment pathway. I'm also struck by how much your treatment plan changed after the compression fracture.

agag | @agag | Jun 24 5:26am

In reply to @michaellavacot "@agag - I did not have any breaks, osteoporosis was a chance finding for me. I..." + (show)

@michaellavacot Thank you for your generosity in sharing what you've learned. My husband and I have watched several of your videos and found them very informative and helpful. I am very much in the bargaining stage, so hearing different perspectives has been valuable. I also found your information about HRT and planning treatment pathways particularly useful. My GP has suggested MHT/HRT, and I'm currently trying to understand where that might fit into the bigger picture, especially given that I'm about five years post-menopause and still within what is often described as the "window of opportunity." You mentioned attending the menopause symposium. If you end up making a video about it, I'd be very interested to watch it. Thank you again for taking the time to share your research and experience.

agag | @agag | Jun 24 5:31am

In reply to @maryandnans "@agag I am 71 and I started on HRT 18 months ago. I had osteoporosis Lowest..." + (show)

@maryandnans Thank you for sharing, so interesting, it's encouraging to hear from someone who started HRT later and still saw improvement in their bone density. Your comment about wishing you had started younger really resonates with me, as that's exactly what I'm trying to work out now. It's also impressive how much work you've put into strength training, balance work and improving your diet.

Can I ask whether your improvement from -2.6 to -2.1 was over the 18 months since starting HRT, or over a longer period?

agag | @agag | Jun 24 5:34am

In reply to @dvargo "@ipg started HRT 10 years after menopause. Increased my bone by 5% in one year. No..." + (show)

@dvargo Thank you for sharing that. It's very interesting to hear that you started HRT 10 years after menopause and still saw a 5% increase in bone density.

Can I ask whether HRT was the only treatment you used, or were you also doing strength training, supplements, or taking any osteoporosis medications at the same time? I'm trying to understand what might realistically be achievable from HRT alone versus in combination with other interventions.