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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 - 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!
Replies to "@mayblin - Correct--no bisphosphonate. I've used vaginal estriol/estradiol for yrs to avoid recurring UTIs as well..."
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@singingbones
Just to clarify my earlier comment about aiming for the lower half of the healthy premenopausal CTX range: this isn’t a standard recommendation or a validated target. It’s an empirical approach some doctors use to gauge antiresorptive effect. The bone specialist I spoke with happens to be one of them.
Unlike bisphosphonates, estrogen comes in many doses (and formulations), and its dose-response with BTMs is less well studied. That said, a few publications (including an ASBMR Task Force report) describe experts using the premenopausal range as a practical signal, for example, restarting treatment of bisphosphonates after a holiday when markers rise above the lower half. The Endocrine Society, on the other hand, stresses that there’s real uncertainty about what an “optimal” BTM response even is, and that serial measurements need the same assay and must exceed the least significant change (around 56% for CTX in their example).
In my case, my doctors had planned to bump the estradiol patch from 25 to 50mcg. The specialist suggested looking for CTX in the lower half of the premenopausal range, but my response to 25 mcg was already very strong, so I was instructed to keep using the same low dose.
So my point wasn’t that guidelines say estrogen dose should be titrated to a specific CTX level - just that some docs use this range empirically, and that’s what happened in my situation. And of course, always best to follow your own physicians, who know your full clinical picture.