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.

dvargo | @dvargo | 3 days ago

In reply to @daisy17 "@dvargo I am 76 so need to discuss this with my doctor. Thank you." + (show)

@daisy17 find a functional

CathyF31 | @cathyf31 | 3 days ago

In reply to @dvargo "@daisy17 I started HRT at 64, now 67. I increased my bone in one year by..." + (show)

@dvargo Are you able to share rhe value of your lowest T-score and are you comfortable sharing how long you were post-menopausal before starting HRT? It appears they want to relax a guidelines of HRT targeting only people 60 and under and within 10 years of menopause. They're trying to make it more individual and not concrete criteria. Just curious to see if you fill outside of the popular parameters.

dvargo | @dvargo | 3 days ago

In reply to @cathyf31 "@dvargo Are you able to share rhe value of your lowest T-score and are you comfortable..." + (show)

@cathyf31 They took the black box warning off this past year. HRT does not cause cancer, however, I am checked once a year by a function doctor. Traditional doctor menopause as grin and bear it. Not her fault. They only have one class on menopause. I stared HRT 10 years after menopause. After 3 years on hormone replacement my spine went from -2.9 to -2.4 in this past year.

CathyF31 | @cathyf31 | 3 days ago

In reply to @dvargo "@cathyf31 They took the black box warning off this past year. HRT does not cause cancer,..." + (show)

@dvargo The faulty study interpretation from 20 years ago re: HRT has done a lot of damage and scared off many patients that may have benefited greatly from that option. They've actually found that some of the HRT actually protects against breast cancer. Anyways, they say the younger doctors are going to be very slow with accepting this change, as they were not educated well on HRT, due to the previous (faulty) black box warningsm for over two decades. I guess the new guidelines are high-lighting the best benefits by targeting patients 60 years old or younger and reaching menopause within the last 10 years. I've also read there is a push to encourage doctors to take each individual patient on a case-by-case basis to allow more flexibility for people beyond 10 years post-menopause and over 60 years old. (?) Sadly, it may take years and years for the damage to be undone and for changes in medicine to catch up. The research is already lacking terribly with OP, so it can be discouraging and confusing for many. Trust in guidelines seems to be an issue as well nowadays.

cliffdweller | @cliffdweller | 3 days ago

In reply to @rn40 "I know each person has to do what is best for them, and each situation is..." + (show)

@rn40
So much emphasis out there on the risks of hormone therapy and so little info. on the risks of osteoporosis medications, which I think are far greater. Scary that so many doctors know so little about the proper protocols for using these drugs. You don’t have to look far to hear of people who had terrible, life altering side effects from these drugs. Not saying I would never use them, but I think it would be a last resort for me.

rn40 | @rn40 | 3 days ago

I totally agree. I had to stop taking HRT at age 62 due to the conventional wisdom at the time as I had ER/PR positive breast cancer. I am now 79, and
I think the HRT ship has sailed for me, but I definitely believe in the benefits of HRT. I believe my osteoporosis was in direct relation to stopping hormones, and then having to be on a hormone blocker for 7 years. I am
very reluctant to take any of the osteoporosis meds, and continue to seek a more natural alternative.