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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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@rjd Thank you. That's interesting, particularly because my biggest concern is the femoral neck rather than my spine. I've noticed a few people mention that hip osteoporosis is more difficult to improve than spinal osteoporosis. Your comment about HRT is helpful as well, as that's one of the decisions I'm currently trying to work through with my doctor.
A quick update: my GP ordered spine X-rays to check for compression fractures, and thankfully none were found. She has also referred me to osteoporosis physiotherapy and to a rheumatologist/osteoporosis specialist who is known for being very thorough. Following the X-rays and a lot of discussion, her preferred option remains HRT. She feels it is relatively safe for long-term use in the right patient. However, when I asked what happens after 5 years, she acknowledged the increased risks, the challenges of starting HRT five years after menopause, and the potential issues around transitioning off it later. For now, she is supportive of me spending the next year focusing on exercise, physiotherapy, diet, calcium, vitamin D and strength training, while I gather more information and see what the specialist recommends. I'm interested to hear what the specialist says next week.
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1 Reaction@agag I think bone health is whole body approach. I have a trainer for weight lifting, I try to get in 10,000 steps a day. Lead with protein for food, Vit. D from Life Extension called bone restorer. I have a vibrating plate at home and I go to Osteostrong twice a month.
@dvargo
Me too. Started at 77. Went through non surgical menopause at 38. Best thing I ever did.
It sounds like a great plan. I've been referred to Purpose Physiotherapy for a consultation, so I'm hoping they'll help me develop a targeted program. I've heard of OsteoStrong but haven't looked into it in detail yet. I head back to work next week after five months of long service leave, so the timing isn't ideal, but I know I need to get moving and build a sustainable routine. Can I ask whether you're doing all of this without osteoporosis medication or HRT, or are those part of your plan as well?
@agag I started exercising about 6 or 8 months before I started HRT. This is still a work in progress. I am constantly trying new impact exercises that truly help build bones. My DEXA scans were about 2.5 years apart.
@gravity3
Thank you for I will share with Drs. Any thoughts on the research surrounding Fortibone ?
@lr Keep in mind that after completing 12 months of Evenity treatment, it is recommended to follow up with a bisphosphonate (Reclast or Fosamax) or another osteoporosis therapy to maintain bone strength and prevent fractures.
@ipg Do a search in this site for "Fortibone" and lots of discussion will come up.
Here is a link to a study showing positive results with collagen containing Fortibone. In this study, Fortibone is referred to as "specific bioactive collagen peptides".
https://pmc.ncbi.nlm.nih.gov/articles/PMC8441532/
@daisy17
Thanks