that's a great synopsis of the various pharmaceutical protocols available and a great question which we all ponder once getting this diagnosis. One thing you might add to that list of potential interventions is bioidentical hormones. If you are within that 10 year window post menopause, it's something to consider. Even post 10 years, something to explore. Risks were highly and inappropriately hyped and overblown after the flawed WHI study was halted but now there is a general recognition that benefits may actually far outweigh risks and the tide is turning in favor of their impact on health and bone density. Even if you have a family history of breast cancer or have had bc yourself, you might possibly use them. The increased risk is very, very small vs. the overall risks of pharmaceutical formulations of which there are many. After much research and consideration for my own protocol, and after an intensive and targeted natural approach that unfortunately led me into more severe osteoporosis, I ultimately had to have a pharmaceutical intervention to regain density lost and chose to go on Forteo for 2 years. Since you need to immediately follow up with something to prevent the loss of gains you made, I weighed all options and decided to follow up with low dose, transdermal estrogen and oral progesterone as the safest protocol I could come up with. I am 67 and have been on hormones for 5 years and have mostly maintained density with slight variation in my dexa scores. I wish I had gone on it earlier and I hope that more women start considering this in their tool kit of options.
If you want to better understand the risks and benefits of HRT, some doctors to read or follow are Dr Avrum Bluming, Dr Felice Gersh and Dr Mary Claire Haver. Dr Bluming has co-authored a book called Estrogen Matters. Dr Haver is very visable on Instagram and offers clear and concise snapshots into studies supporting HRT use as well as study-based rebuttals to common misconceptions and misrepresentations in the media and particularly on social media. Dr Felice Gersh is an integrative gynecologist and a hormone expert for decades.