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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
@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.
Replies to "@singingbones, thanks for sharing! The baseline BTMs are unfortunately not reliable, mainly due to biotin and..."
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@mayblin - Correct--no bisphosphonate. I've used vaginal estriol/estradiol for yrs to avoid recurring UTIs as well as 100 mg prometrium oral capsules. My new dr added the systemic dose of transdermal gel of 0.25 mg in April to begin to address bone health. I will be seeing her at the end of this month to see how she wants to proceed in terms of modification.
My Evenity prescribing dr is actually an orthopedic surgeon (no longer doing surgeries). She has no interest in BTMs, as she says DXA is sufficient. My recent DXA was nicely timed w/the end of the Evenity course, so she was satisfied. That's why I'm self-paying for my own BTMs. I'll ask my PCP for those labs next time, but I still plan to get them done more frequently for my own peace of mind.
Yes, we are trail-blazing a bit for sure. I have read of personal success stories on Inspire.com where others have chosen HRT as their follow-up antiresorptive. I do appreciate that drs need to follow the studies and they are sparse or non-existent for this protocol.
Pls unpack your statement for me: "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." I want to understand this better. Thanks!