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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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@gracie7 I believe my doctor and team chose this for me as the safest option considering my need for bone support and age. That's why it's so important to do your own research and discuss with your health care provider.
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2 ReactionsDr. Harold Rosen gave a informational session & posted this slide. Seems that -2.5 is a delineating DXA level. If you haven't tried the other recommendations, you could decide to do that. I was -2.6 and had been lifting weights, getting Calcium, Vit D but still continued to drop to -2.9 so went on fosamax about 6 years ago. Now am -1.9 & "on holiday"(off fosamax) until next Dexa.
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1 Reaction@njx58 what meds do you recommend? that's where I am having a challenge....... I was on Fosamax less than a month --- esophagus issues stopped it
I'm at a loss....
anyone have suggestions....they all kinda scare me.
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1 Reaction@dtevis: since you have experience being on Fosamax I hope you can answer my question:
Can I take Pepsid OTC while taking my weekly 70mg Fosamax?
I have received conflicting info: does the Pepsid surpress the effect on bone sealing in the progress from my year of Evenity? Please help.
@dbamos1945 Even though I have taken Fosamax, I don't know about Pepsid OTC as I have not taken any antiacid medications. You likely already saw this AI comment: Yes, taking Pepcid AC (famotidine) can decrease the absorption of Fosamax (alendronate) if they are taken at the same time.To maximize the absorption of Fosamax, health experts recommend following these steps:Wait 30 Minutes: You should wait at least 30 minutes after taking your Fosamax before taking Pepcid AC or any other acid-reducing medication.Follow strict fasting rules: Fosamax must be taken first thing in the morning with a full glass of plain water, at least 30 minutes before your first food, drink (other than water), or other medications.
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2 Reactions@dtevis: Thank you so much. I have only taken two week’s pills, but worried about Gerd at bedtime. This info will allow me to take Pepsid to prevent a Gerd episode in the night. I really appreciate you!
Exercises for the hip
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2 ReactionsI just wanted to post an update and say a huge thank you to everyone for your kindness, support, and suggestions. In particular, after reading @oopsiedaisy's comments, I asked my GP for a referral to a rheumatologist. I also requested a repeat DEXA scan and additional tests, including parathyroid hormone (PTH) and a 24-hour urine calcium test to check for any underlying causes or excessive calcium loss. Both came back normal. While waiting for the repeat DEXA, my GP also encouraged me to complete the Australian iPrevent online breast cancer risk assessment. It now incorporates breast density, which is now routinely reported with mammograms in Australia, and is particularly useful when discussing whether HRT might be appropriate.
The repeat DEXA results were very different:
• Spine: T-score -0.8 (previously -1.2)
• Left femoral neck: T-score -1.4 (previously -2.8)
• Right femoral neck: T-score -1.5 (previously -2.3)
• Total hips: -0.5 and -0.9 (previously -1.7 and -1.9)
This was a huge surprise and a real wake-up call about the importance of advocating for yourself and actively focusing on bone health. My GP is still encouraging me to consider HRT, although there isn't a clear plan beyond five years. The rheumatologist's approach is quite different—they would wait until my FRAX risk reached 20% or my T-score was around -3.0 before recommending osteoporosis medication.
For now, my GP has given me a year to focus on lifestyle changes before making any decisions. I'm now consuming around 1,300 mg of calcium a day from food, taking vitamin D, and I've found a fantastic physiotherapist with expertise in osteoporosis. I've been doing my prescribed exercises five days a week, and next month we'll start introducing resistance training and weights.
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2 Reactions@dtevis
Are you on hormone replacement? Will you go to an anabolic if the next dexa shows loss?
@agag
I find it strange (troubling) that the rheumologist would wait until -3 T Score before medication. Wow! What was the rationale in that?
If you can do HRT (within 10 yrs of meno), seriously consider. I wish I had had that option. Sadly when I was that age, doctors weren't prescribing due to faulty research.
Also, why did you think you were losing calcium? The 24 hr urine test is the gold standard to measure, yet yours was ok (fortunately).