Bioidentical hormones for osteoporosis

I am 16 years post menopause and visited my gyn yesterday to discuss BHRT. I am a healthy 71 year old with osteoporosis and am scared of osteo meds. My gyn and I talked for quite a while. She talked to me and not at me. She said she would prescribe HRT if I got a clearance from a cardiologist and also gave it more thought. She mentioned the risk of blood clots and wanted me to think about the risks of blood clots versus the risk of broken bones. I have given it a lot of thought and decided to continue with diet, exercise, supplements, low intensity vibration. I hope that my CTX score will improve over the very bad score from last May by the time I visit my osteoporosis specialist next April.

Did she say it was still a risk if it is transdermal?

My gyn says the same thing about the risk of stroke. However, The American College of Obstetricians and Gynecologists study says this:
https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2013/04/postmenopausal-estrogen-therapy-route-of-administration-and-risk-of-venous-thromboembolism
"Studies that compared oral and transdermal ET have demonstrated that transdermally administered estrogen has little or no effect in elevating prothrombotic substances and may have beneficial effects on proinflammatory markers, including C-reactive protein, prothrombin activation peptide, and antithrombin activity. Also, in contrast to oral ET, transdermal ET also may have a suppressive effect on tissue plasminogen activator antigen and plasminogen activator inhibitor activity.

"The Estrogen and Thromboembolism Risk study, a multicenter case–control study of thromboembolism among postmenopausal women aged 45–70 years, demonstrated an odds ratio for venous thromboembolism in users of oral and transdermal estrogen to be 4.2 (95% CI, 1.5–11.6) and 0.9 (95% CI,0.4–2.1), respectively, when compared with nonusers 10. Transdermal estrogen had no increased risk compared with nonusers"

Mine indicated she didn't really want me to pursue that path, so good for your doc setting parameters for your consideration. Good luck on your journey. I am seeing Dr. Bush for a REMS ultrasound in February and his will be the first consult I do with someone who specializes in OP. I did see a functional medicine doctor this summer who had specialized in endocrinology and she told me I did NOT have OP because my Z scores were fine. A creative way to wash her hands of my biggest concern!

I specifically asked about a patch.

I am considering seeing Dr. Bush if I am not happy with what my osteoporosis specialist has to say at my next appointment in April (after more bloodwork).

I have had such pain in my joints and muscles with Prolia and (not as severe) with Reclast, that I am wondering if the bioidentical hormones are the answer. My endocrinologist is insisting I go on a biophosphonate, but I do not want the side effects. I am 78 yrs old. Has anyone had good experience with the Bio identical hormones ?
Thank you

I am in the same situation as you are. I was on bio identical creams for 20 years had great success now my integrative medicine doctor wanted me to go on the pellet therapy because it has better delivery. I am two months into the pellets and will go back for blood work next month, he said he could turn my osteoporosis around in a year and I’ve read this and heard it from one of my friends. I am willing to take the risk and try this. You need a Doctor Who has total experience. My doctor is in the Philadelphia area and is very knowledgeable about hormone therapy , I will send you his website and you go on there and read all about it. He does do telemedicine appointments very thorough keeping up with the blood work so your dosage is correct.

You didn't mention the MG your current estradiol transdermal patch is. I am also 74 and healthy (according to my blood workups). I take one medication a day, a low dose of 10mg of simvastatin to manage my high cholesterol. My lipid panel and Chol/HDL are all within normal limits. I understand that .05 mg is the lowest "effective" dosage for bioidentical transdermal estrogen for osteopenia/early osteoporosis. The 2000 Women Health initiative used .625 mg ( a synthetic and 12x more than .05) and ran into problems. Transdermal estrogen patches are recommended at an intervention stage for osteopenia and early-stage osteoporosis in "certain" circumstances.
It's been 30 years since I had my partial hysterectomy due to endometriosis. Four years after my hysterectomy I started bioidentical transdermal bioidentical estradiol patches. In 2005 I stopped due to inaccurate news from the Women's Health initiative. If I had the accurate correct information I would have never stopped. After that, I switched to bioidentical vaginal "Estrace" estrogen. When I was 64 (2014) I used a topical systemic bioidentical compounding cream combination of estrogen and testosterone for a year. For the past 10 years, I have only used compounding vaginal estrogen. I have yearly blood hormone lab work-ups done for levels of estrogen. All of my lab results showed a negligible amount of estrogen. None of the "local" vaginal estrogens were systemic.
On 6/21/2022 I had a Dexa scan that showed I had a T score of -2.5 Osteopenic. T score of the left femoral neck is -1.7 and T score of the left hip is -1.4. I live in a state that is 2nd to the last worst state for health care due to a severe shortage of doctors. It has taken me 2 years to find a doctor and then go through long wait times to see one. I have a good endocrinologist now. She says after having a full workup of my health she has no concerns about giving me transdermal bioidentical estrogen to treat osteopenia and early osteoporosis. She started me off at 0.025 estradiol transdermal patch. She said she couldn't start with the .05mg because she needed to get a baseline and start slow. In 3 months hormone lab work will be done ( .025 mg, only trace systemic amounts) She will move me up to the .05 RX. I get my two-year DEXA scan on June 24th. She said it didn't matter what age you started estrogen it depends on your health circumstances, whether you have a uterus or not, have diabetes or prediabetes, heart disease, have had cancer etc. She also said there is no age that you have to stop taking estrogen. The Women Health initiative says using a bioidentical transdermal estrogen patch lower than .625 has not shown any correlation with strokes, cancer, or blood clots.

I am wondering what blood serum level needs to be obtained from a .050 patch to be effective for osteopenia/ osteoporosis for building bone?