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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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@nycmusic
I get it. I had forgotten that you had posted about the CRC.
This may interest you and others:
Next OsteoBoston Session:
Our next session will be held on Tuesday, Aug. 4th at 7 pm when we host
Endocrinologist and researcher, Dr. Amanda Clark on Menopausal Hormone Treatments--everything you'd want to know about HRT therapies. I can't wait to hear about it.
Osteoboston always uploads these presentations to you tube at some point after the Zoom meeting.
@gravity3 thanks… like you, I just want to keep learning here…just saw 2 docs and 1 said at 81, she doesn’t like the risk-benefit ratio of any HRT for me….my Primary whom I have had for many years says my overall health picture is so good with strong recovery fromCRC, that she doesn’t feel I need to add meds and tests at this time. To continue what I’ve been doing for now… I trust she will know when to step in, based on my excellent experience with her over a long time.
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1 Reaction@nycmusic Hi - I am 75 and taking BHRT to see if it makes any difference in my bone health.
I gave up mammograms years ago, only using thermography, but I may have to go back to mammograms now. I am not too worried about any side effects, however, as the bioidentical ones are a lot less harmful. I am feeling great and sleeping very well now while on it; not using THC anymore.
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2 Reactions@nycmusic Hi - I am 75 and taking BHRT to see if it makes any difference in my bone health.
I gave up mammograms years ago, only using thermography, but I may have to go back to mammograms now. I am not too worried about any side effects, however, as the bioidentical ones are a lot less harmful. I am feeling great and sleeping very well now while on it; not using THC anymore.
To add to this thread, I got no information from my rheumatologist on pharmaceuticals but my functional medical doctor also uses BHRT and is monitoring me. I have several friends who had taken Prolia and say it is fine, but one ended up with a broken back 5 years into treatment.
I think the meds prolong the inevitable along with various side effects, but if my scans get worse, I will try Fosamax. My sister was on and off it for 3 years and is now osteopenia and on nothing.
I am not going to stress over this (femurs both -2.8) and live my life, albeit carefully :-). I agree with the comment on valuing my quality over quantity of life.
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1 ReactionThanks for this very good post…as of now, i haven’t added meds or HRT/BHRT patches….just doing what I can with more natural ways including exercise and very focused PT….doc doesn’t want to change things when a patient is doing well… at 81, having survived CRC, I really am concerned about quality of life…i trust my excellent doc will guide me when needed, as she always has, as we are a good team… Wishing you the very best for a really good life !
@gracie7 Also in my 70s, I've started Menostar patches which are ultra low dose and also for bone support only. Could you share if you are on similar? Thank you!
Keep us informed of how well it’s working for you. Good luck !
@tillymack Hi -
I have never heard of Menostar patches; would like to know more. I am on estradiol 0.025 mg/day, 2x weekly along with compounded progesterone 100mg. My bone coach is on the same but her dose is 200mg. I have read that too much progesterone can inhibit bone health so I hope to stay at 100mg.
Apparently, there is a 'shortage' of estradiol patches so they are carefully releasing what they have as needed. That makes me nervous so I would like to research what you are on. Thanks for sharing.
@gracie7 A quick Google search using Menostar in the search box retrieved many articles which may be of interest. You can also search on this site as there has been some conversation about this here as well. And of course, you would want to have a thorough discussion with your prescribing practitioner. Best of luck!
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1 Reaction@tillymack Oh thank you so much! I will research it and talk with my doc. I thought that 0.025mg was pretty low and a good place to start. So now I wonder if the dosage matters as to how effective it is....does a higher dose work better on the bones than a lower dose or doesn't it matter, any estrogen at any level makes a difference, and maybe a higher dose has a greater benefit?...just wondering.