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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
Please share your age as a Drs decision to introduce HRT can be influenced by age as one factor from some of the readings that were shared. Good luck!
@ipg
Sorry. But you might plug fortibone into the search box.
@dvargo 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?
@ipg thank you for responding, I'm 57 , I explain my details in the original post.
@maryandnans Thank you, that's really helpful. It's interesting that you started exercising before HRT and that you're continuing to refine your impact program. Can I ask whether your DEXA showed any improvement over those 2.5 years, or has your main goal been to slow further bone loss? I'd also love to hear which impact exercises you've found most worthwhile.
@daisy17 yep, Evenity and the follow-up treatment, this generally becomes an ongoing process for the rest of your life? That's the part I'm struggling to get my head around.
@agag
I take high BP meds and thyroid meds so it is not a stretch for me to know that I will probably be taken op meds too.
@agag doing all this WITHOUT medication but I do take HRT.
@agag
What did she mention as the challenges of starting at this point in time?
Do some research before you believe the antiquated responses of doctors regarding hormone therapy. I’m on hormone therapy now, but I lost a lot of bone being confused and misguided about the risks of hormone therapy. Most doctors are way behind on the research regarding estrogen therapy. The guidelines are well behind the research depending on which medical society you look at. The mantra of “lowest dose for shortest period of time” has no evidence behind it. The women in the WHI study were much older than when we typically prescribe hormone therapy. It was never the estrogen that was a problem in the WHI study. In fact, the estrogen only arm showed it was protective for breast cancer. The estrogen plus progestin arm showed a slight increase in breast cancer. It was something like 8 additional cancers per 10,000 women. With no additional deaths. That did not make the press. Check out the book Estrogen Matters, written by an oncologist whose wife had cancer. He breaks down the faulty research. Also, check out Dr. Lauren Stricher; a menopause expert who is evidence based and great at interpreting the data for women.
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4 ReactionsAs discussed in this podcast with Dr. Stricher, there is no need to go off hormone therapy; women may stay on it indefinitely unless there is a medical reason not to:
https://open.substack.com/pub/drstreicher/p/your-bones-on-and-off-estrogen
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