Young woman diagnosed with osteoporosis

Your spine is pretty bad. I got fractures with a score that was the same. I strongly suggest you advocate for Tymlos, Forteo or Evenity. I know that Tymlos is really good for spine: I had a 20% gain and went back to -2.5 which is borderline.

The only reason docs start with bisphosphonates is insurance. You can bypass that by calling the companies. There are coupons available and patient assistance programs, as I wrote before. Or take a bisphosphonate and then "fail" it. Or get your doc to do an aggressive medical authorization given your unusual situation.

I had breast cancer that was hormone driven. Even after menopause the adrenals and fat produce estrogen. The concerns of that study have been questioned since it came out. There are bioidentical forms of hormones but you may need a functional medicine doc or integrative gynecologist.

Being without ovarian estrogen at such a young age has its risks too. What is the family history of breast cancer? Mother, sister? Was it determined to be genetic? My breast cancer is not genetic so even my daughters are not concerned.

Ironically I usually comment on here about cancer risks when women are going on HRT for bones. But your situation is so different. I don't know what the right answer is. It is exhausting to try to find the right docs and balance differing opinions.

I strongly suggest a consultation with Keith McCormick. He is easy to find online. I will PM you.

@windyshores

Thank you for your reply and for the PM as well. Yes, it might be worth it. To be honest, I would give anything and everything, just to get the right answers and treatment. The dillemas are exhausting on itself.
Family history is on my mum's side, a lot of her female relatives got breast cancer. 3 of my aunts, to be specific. I don't know if that's significant, but I think it still counts a risk.

My feeling is for most women, with no history/family history of breast cancer, HRT is the way to go. Given that breast cancer runs in your family, I get your concerns. Maybe genetic testing could help.

sorry, probably the wrong wording to use on my part. Yes, clearly in the osteoporosis category and since you have lost a lot of density in your spine in particular, Forteo or Tymlos would likely be a good option for you.

Hope you are able to move forward with a good plan to restore your bone health!

Don't worry, it wasn't the wrong wording... I'm aware that the scores on my spine are very, very bad. I'm scared of losing my height and losing my posture, but most of all, I'm scared of fractures. Of losing my independence... It has gotten to a point where I become too aware of every movement. I love walking and I do it on a daily basis, but I'm not confident to get a gym membership and lift weights (even thought it might actually help).... because I'm afraid that I will somehow "crush" my spine. Maybe it's just my anxiety speaking. But I'm being honest now.

I have one more question: Why is it that more often, the scores in the spine are worse than the ones in the hips? It's a pattern that I notice in many people.

We all have those fears and they can be so consuming with our bones constantly on our minds with every move we make. Once I went on Forteo, I felt the anxiety release as I was hopeful I would regain some of my spine. That sense of relief is worth its weight in gold. Now I am only on HRT and maintaining but always worry whether it is enough. What I have found helpful is to address my bone loss from all angles, nutrition, movement and meds. You might find Melio Guide and Sherri Betz, both Physical Therapists specializing in osteoporosis, very helpful. Melio Guide has an extensive online presence and lots of informative videos. Sherri Betz has a few terrific videos online and I believe you can book private instruction with her. You can consider wearing ankle weights around your house for additional weightbearing that shouldn't tax your spine (start low) and maybe get some exercise bands which can be used in a safe manner (again, watch their videos as you really need to re-educate yourself on how to move safely). Mostly, avoid curving your back forward, always bending with a straight spine and from the hips, and avoid twisting or turning your spine to end range.

Generally in menopause, we lose trabecular bone first which is what the spine is primarily made of, followed by cortical bone which is largely what the hips are made of.

It really is a whole re-education of living our lives. But if you approach it from all aspects and are diligent in your positive attention to it, hopefully you will restore some of what you have lost.

by the way, the increase in breast cancer rates on HRT that were cited in the WHI study was about 26%. That sounds huge. In our daily lives, the risk of developing breast cancer between the ages of 50 and 60 is 2.33%. On HRT, according to that study, the risk increased from 2.33% to 2.94%. That's the 26% percent increase, actually a very, very small increase. That means that for every 10,000 women, an additional 8 women will get breast cancer. In the study, Premarin - oral estrogen, was used along with synthetic progestin. Both are considered much less safe than transdermal estrogen and bioidentical progesterone so actual increased risk may even be smaller than was determined by the study. For some people, any increase in risk is too much risk so it's a really personal decision and one that should be explored with a menopausal specialist that has a thorough grasp of all the nuances.

Thank you once again for the helpful suggestions!
I'm trying to stay as active as possible, and I really enjoy it, it makes me feel better physically and mentally, however the fear is still present.
I consider walking to be my favorite form of exercise because it is not too strenuous and I enjoy the outdoors. But I still watch my moves, of course. Even my daily walks give me anxiety these days.

Do you think it is possible to regain all the lost bone density? Does it depend on age? Or is there some point in the T-score where it is still possible to turn it back?

I'm not sure it's possible to regain all of the density lost but since you're young, who knows? I'm not sure those questions can be answered definitively. A consult with Keith McCormick would really be helpful to steer you in the right direction.

Glad you are still enjoying walking!

How do hormones play a role? An online doctor (justAnswers.com) told me to see a rheumatologist. But my primary referred me to a spine specialist. Having osteoporosis, should I see a rheumatologist?

How has a hormone imbalance contributed to your osteoporosis?