Help finding HRT over 10 years post menopause

*2026 May. I am newly diagnosed with spine osteoporosis, a diagnosis a result from pain radiating to “under my (front) ribs on left side. An X-ray performed finding “age related compression fracture” in my spine from a fall several months prior.
Jumping back…,
*2017 DXA results: “L1-2 excluded for significantly different results when compared to adjacent vertebrae”.
AP Spine (L3-4) -0.91.1 normal. This is 2017.

*2026 DXA (after that Xray) gave results;
femoral neck 0.655,
total hip left 0. 835,
total fore arm right, 0.450,
1/3 forearm right, 0.533,
UD forearm right 0.352.
There was no scan of my Spine saying that they were not able to do that area!!!

I don’t understand this?
If I go onto the recommend RX anabolic 2yr treatment for the diagnosis of osteoporosis of the spine (due to my compression fracture), how will they monitor my spine’s improvement, if they cannot take a DXA of that area, prior?

I read here about the details of improvements to the bone in the spine of those on Rx therapy. Is that totally from undamaged spines, with no compressions or herniations?
Does everyone else get Bone Density tests of their Spine?
I’d like to hear your input and experiences, because I feel I need to push back on this, before I commit to Rx therapy.
Thank you very much.

@cliffdweller
Thank you for getting back to me.
I thought I listed my scores in my monologue written/posted? But I can’t find my post here now! Geez! Maybe the administrator took it down? I’m obviously new here. I was hoping for more input from others, and I really appreciate your suggestions. I will research what you said and discuss with my endocrinologist. I haven’t heard back from her yet, regarding my labs performed last week, Thursday.
The 24 hr urine test and 11 other blood tests all came back totally within normal range, except creatinine lab, which was a few points below the lowest (normal) range suggested. (I am able to log into my medical chart, to view results, although they have not been signed off on yet by the (ordering) MD.). So with all positive results - I don’t know what’s going on. It scares me the thought on going onto the anabolic Rx, since I’ve read the side effects, and also read the struggles many people have had.
Thank you again. I wish you well on your health journey.

@countryliving I think many of these questions regarding your DEXA scan what the results mean are questions you should ask your doctor. Remember that bones change very slowly, so you have time to get answers to your questions before you make a decision about bone drugs. It's normal to feel scared. Again, you have time to research things and get answers to your questions. Don't feel pressured to make a quick decision. There's lots of information on this site and people willing to help.

Usually the DEXA scans the lumbar spine. The upper portion of the spine is not included in the DEXA scan because the ribs are in the way.

Check out Brick House Bones on Facebook by Dr Lisa Moore, a PT specializing in osteoporosis. She has free exercise videos and information, although drugs are not discussed. The Better Bones website also has great information.

Here is a link to discussion that might be helpful regarding tests that are available. https://connect.mayoclinic.org/discussion/bone-scans-explained-and-what-your-results-really-mean/

@countryliving

Which anabolic?

@jozer

May I ask how old you are? I ask because at 78 I consider myself to be in quality of life over quantity of life mode. I went into spontaneous early menopause at 38....just like a faucet turned off and never turned on again. I didn't have a clue about osteoporosis risks due to loss of hormones nor how menopause would effect other important parts of my life especially loss of libido. Decades later came osteopenia the docs advice for dealing with it..... don't fall. I just went on with my life and about 12 years ago began drug treatment for Osteoporosis. When the information began to break about the flawed women's health initiative study I began to wake up. I was pissed that I had lost so much because doctor's were using that study to deny women hrt/bhrt rather than look at the whole picture. So at 77 I found a functional medicine provider who was delighted to start me on bhrt with testosterone. It is important that I mention that my mother died of ovarian cancer at 48. I was never tested but I felt confident in my choice to start bhrt . I desperately wanted my libido back and wanted any other positives that came along with it.
My path is not for everyone. I had to explore how I might feel if I did develop breast cancer that Might repeat Might be related to use of bhrt. The actuarial tables speculate that the average age of death for someone like me is 84. I am a devout pragmatic when it comes to my own death. I have no desire to live until 85 or 90 let alone 100 (ghastly thought). So I dove in and am very happy. I'm having better sex than I did in my 20s or 30s. I don't have urine incontinence or senile purpura any more. For me this is quality of life. It is obviously not for everyone. Just offering my story if it is helpful in any way. Good luck in your decision making.

@gravity3
Which anabolic you ask me? I had my initial consult visit with the Endocrinologist last week, Wed. 6-10-26. She had reviewed my maintenance Bone Density exams done at the same facility starting with:
10/2000,
02/2004,
09/2006,
08/2011,
10/2015,
11/2017, last one of L3-4
04/2022,
05/2024,
05/2026
Her thought was for me to use Forteo (teriparatide) pen, self injections for up to two (2) years, to build bone, followed by an antiresorptive agent to maintain the bone built (decided towards the end of the two years).
Her clinical observation would be supported or adjusted after the lab studies she wanted me to complete, which I did do the following week, 6-18-26.
The lab studies ordered:
Creatinine 24 hour urine, a fasting CMP (comprehensive metabolical panel), Collagen Type 1 C-Telopeptide,
IgA,
PTH,
Phosphorus,
Protein Electrophoresis serum,
TSH,
Tissue Transglutaminase IgA,
Vitamin D 25-Hydroxy.

I am waiting to hear back from the Endocrinologist office. In the meantime,I am doing my due diligence, and after I hear back from the office, I may seek a second opinion, supplying all my radiology and lab reports.
I will make no treatment decisions until November at the earliest.

Where are you, on this osteoporosis journey we share?

@gravity3 I get so mad about that damned study. There are days I wish we could all file a class action suit against them...but that's just wasted energy. Thanks for sharing your pragmatic perspective. I had written off HRT (I'm 65 and about 15 yrs postmenopausal) but I think it's time to rethink my thinking. I don't know much about functional medicine so it's time to learn something new!

@countryliving

I started 12+ years ago. I knew nothing and didn't find resources. I wish I was starting my journey now......scratch that..... I wish that I had been started on hrt after my spontaneous early menopause at 38. I don't know if that would have changed my dx of osteoporosis but certainly adding more strenuous weight bearing exercises would have helped my bones along with hrt. Because I had osteopenia and my U. C. Davis PCP told me not to fall as a treatment plan I did not begin drugs intervention right away. Anyway I was given alendronate for 3 years, then forteo for two, 2 more years of alendronate ( during that time I had no idea what the drugs were supposed to do or whether I could have side effects. I had some minimal gains from forteo. I then had 1 year of evenity. I have just had my 4th shot of Prolia and now am considering whether to get one shot of reclast to deal with Prolia rebound hoping I'll get to have a drug holiday.
On a brighter note I have not had noticeable side effects with any of those medications.

@gravity3
It is amazing you have had no noticeable side effects with any of the Rx medications you have used! That truly is a very good thing. I hope I will be as fortunate, once I start.

You said you don't know if starting HRT at 38 yo would have changed your dx of osteoporosis? I’m pretty sure it would have delayed it, like I feel it did for me. I was 39 yo when I had to have a total (non-cancerous) hysterectomy. Fortunately, my OB/GYN Nurse practitioner immediately placed me on Premarin tablets. This was 1990! I used oral HRT for many years, I think to about 55 yo, when natural menopause would have occurred. Then, Premarin was stopped, and I was placed on Femring, a three month ring worn internally. Due to insurance coverage-the lack of it-for “Femring” product, several years later, I changed over to Pfizer Estring (7.5 microgram/24 hours internal ring delivery system. Estradiol Hemihydrate). I am still using it and I’m 75 yo and just moved from osteopenia into osteoporosis. I did always have a lot of physical activity in my lifestyle, and a very calcium rich diet, along with an over the counter vitamins and minerals routine.
The Corvid pandemic starting Jan 2020 and the next two to three years, I feel set me back big time health wise. I never got Corvid but the early isolation, change of anct levels, and different eating style due to less shopping trips and access to easily buy fresh fruits and vegetables, etc., took bone mass from me. Or else those years coming forward are just the normal aging process catching up to me. I don’t know, but I have boarded the darn osteoporosis train.