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My HRT patch was prescribed by my gyn. She will not prescribe a higher dose. I did still have bone loss and reached out to an OB-GYN bone specialist at Georgetown University. She's recommending Forteo. She said I could stay on my low dose of HRT while I'm taking Forteo. We're scheduled to more fully discuss transdermal HRT. She says there is a greater risk of stroke after the age of 70. I keep reading studies like the one I posted here from ACOG that say otherwise, which is what I want to talk further with her about. We have already talked about it a little but she's adamant about the stroke risk . What I'm curious about is this: is the risk of my having a stroke greater than the risks of the other first-line osteoporosis treatments like: osteonecrosis of the jaw; spontaneous femur fractures; stroke; osteosarcoma; loss of teeth; renal impairment; difficulty swallowing; increase risk of blood clots; digestive disorders, etc etc? It seems like I'm not only still at risk of a stroke, but that I'm adding a number of other terrible side effects to that risk.
I do plan to take Forteo, but am hoping that after that I might be able to just increase my HRT dose a little to maintain whatever gains I get from Forteo. I'm on the lowest dose (.014), 1x a week of Menostar w/100mg of Prometrium 3x a week. Sorry this is long.
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I completely agree with your thinking! There are risks to every drug option and I'd rather take the risk with something my body naturally recognizes and offers so many additional benefits aside from bone density maintenance.
That is a super-low dose of estradiol you are on. I didn't even think it was offered at such a low dose. The doses I have seen listed that are helpful to bone start at .025 and I thought that was the lowest dose offered. I've been on .025 transdermal for about 5 years. I've mostly maintained my density (same overall dexa score) with a couple of vertebrae that show loss so that concerns me a little. I've recently seen an integrative gynecologist who is bumping me up to .037, a very small increase. She would definitely go higher but I'm concerned about the potential of increase in breast size. If you are considering increasing your dose (after your course of Forteo sounds like a good plan), it might be a good idea to assess your stroke/CVD risk if that is a concern. I've had my detailed cholesterol numbers done which most doctors don't order. If you ask for them, they might. I've tested LPa (genetic marker and hard to lower. fortunately mine was low), oxidized LDL (whether your particles are small and dense which tend to clump and form plaque), and a CT scan to determine calcium score. My calcium score was 0 which means there was no discernible plaque detected in my arteries as of yet. I'm tweaking a couple of things to try and keep it that way but since my risk appears to be low, I'm comfortable with continuing on the HRT and increasing my dose. Unfortunately, most doctors don't do detailed cholesterol bloodwork to really get a good determination of risks so it's important to ask.
Thanks for all the information -- I so appreciate it! And you do raise a great point about relative risk (HRT & stroke vs. osteoporosis meds and all their potential problems). I am 71 and have been warned about stroke risk, but I am interested in HRT after I finish the course of the injectable I'm on (Tymlos). Will have to find a knowledgeable doc!
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I’ve never been on HRT and just turned 76. My GYN said he prescribes a bio identical testosterone implant which helps with bone density and several other benefits. However if u have a bad reaction to it, u r stuck with it for 4 months as it cannot be extracted.