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Effects of HRT: Alone, in Combination or Sequencing
Osteoporosis & Bone Health | Last Active: 1 day ago | Replies (121)Comment receiving replies
@mayblin - here's my convoluted, less that ideal BTM, Evenity, HRT, BTM journey so far:
July '25 (prior to Evenity) - P1NP: 34 CTX: 444 (fasting, but not informed about avoiding biotin or collagen)
July '25 - begin Evenity (spine -3.5; hips both -2.8)
Apr '26 - begin HRT
June '26 - last Evenity injections
July '26 - DXA: spine 1.0; hips -1.9 (great improvement after Evenity)
Aug '26 - P1NP: 21 CTX: 177 (different lab, fasting, early morning draw, no biotin or collagen)
As we've discussed, BTM have their own unique pathway following Evenity. I don't know if the HRT would have had much impact from late Apr to early Aug. No BTM were taken during or after the Evenity course except for the self-pay ones that I'm reporting right now.
I suspect that Evenity is still being reflected in the BTM results (I saved the chart you sent). At least I'll have my own baseline to work from as I consider another draw 3-mo from now and then again 6-mo until I see a pattern emerge.
I should have tagged this onto another thread...but couldn't find it!
Replies to "@mayblin - here's my convoluted, less that ideal BTM, Evenity, HRT, BTM journey so far: July..."
@singingbones - correction: my DXA spine went from -3.5 to -1.0 - considered a 15% increase as per my dr.
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@singingbones, thanks for sharing!
The baseline BTMs are unfortunately not reliable, mainly due to biotin and collagen effects on the CTX, and the differences in assay methods because different labs were used.
I may have asked before but couldn’t recall, what’s the dose and form of estrogen you are using now? You are currently on HRT only without a bisphosphonate right?
The recent CTX of 177 is a nice reading. Does your endo have a CTX target during maintenance phase? I’ve read and was advised by a bone specialist to target the lower half of the healthy premenopausal range with HRT during the antiresorptive phase. That said, you are only about 2mo out from your last Evenity injection and about 4mo into estrogen - so the expected CTX rebound after stopping Evenity has just begun to play out, while estrogen has not yet reached its maximal effect on bone. The true trajectory will only become clear with continued monitoring.
HRT is a recognized antiresorptive. However, the evidence for maintaining bone gains specifically after Evenity is for bisphosphonates and Prolia, not yet for HRT. I’m in a similar boat as you.