Taken early in menopause, it appears to be very protective of the heart, brain and bones. Post menopause, there is a small increased cardiovascular risk in the first year of use that seems to diminish after that. If you have a personal or familial history of CVD, that might preclude its use. We don't really know what the true risk of breast cancer is as that very small increase in cases noted in the WHI study (1 additional case per 1,000 women) was with oral estrogen and as you've mentioned, overall risks may be lower with transdermal. There was no increase in death from breast cancer. We really need new studies done with bioidentical transdermal estradiol to determine true efficacy and risk.

After my full course of Forteo, I opted to go on HRT. I was about 62 at the time, 10 years post menopause so not ideal according to the studies but I still felt it was the best option for me. That was about 5 years ago when docs were still abiding by the post-WHI study data, being risk averse to HRT. I finally convinced my endo that it was the best option and he agreed to "lowest dose for shortest amount of time" which, at that time, was the mantra. The acceptance of HRT is gaining as a preventive but not as much for the preservation of bone (though it used to be used as a pharmaceutical in osteoporosis for that purpose). I am now seeing a menopause specialist who is extremely experienced in the use of HRT (for decades). She is evaluating my bloodwork and history to determine whether I can increase my dose. Though the low dose I am on has mostly maintained my gains from Forteo, overall, things could be better. I will be seeing her for a second appt next week to evaluate.

We have to make tough decisions when diagnosed with osteoporosis. All drugs have side effects. Forteo was my first choice to increase my bone density as it is a hormone that the body recognizes and utilizes. I went on HRT for the same reason. Overall, we have to take some sort of risk with any drug we opt to take so best to evaluate risks vs benefits of each option to make a decision we are personally comfortable with.