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Effects of HRT: Alone, in Combination or Sequencing
Have you used HRT as the sole modality for osteopenia or osteoporosis? How about using it in a therapy sequence or in combination with another osteodrug, either an anabolic or an antiresorptive? What is the outcome of such choice(s)?
After a diagnosis of osteoporosis nearly 3 years ago, I elected Forteo as my first drug therapy then transitioned to HRT afterwards. Forteo gave me a jump start on building bones: lumbar bmd +8.6%, hips r/l +4.8/2.2%, femur necks r/l +8.9/3.4%. Bmd improvements are as follows after 22mo Forteo followed by 6mo HRT (scans were done with same machine and by same tech):
Lumbar spine bmd +18%, T score from -3.4 to -2.3;
Right hip bmd +9%, T score from -2.3 to -1.8;
Left hip bmd +4.1%, T score from -2.1 to -1.8;
Right femur neck bmd +16%, T score from -2.4 to -1.6;
Left femur neck bmd +9.8%, T score from -2.5 to -2.0;
TBS from 1.264 to 1.322
So far so good but I know this is just the start of a long road ahead.
I’m very grateful for the existence of Mayo Clinic Connect. Without this forum I’d never thought HRT would be in the cards as I’m more than 10 years past menopause. Many thanks to @vkmov for initiating the thread “Transdermal HRT”, @teb for her generous sharing of personal experiences, and countless members for their in depth discussions and suggestions.
The inclusion of HRT in the management of osteoporosis isn’t mainstream, in fact it is not approved for the treatment of osteoporosis so data and evidence are lacking. It will be helpful if we could share the outcomes of HRT among those of us who have chosen to use HRT under the care of our team of physicians. Dexa results possibly with bone turnover markers and/or TBS info if available will be nice. By the way, my CTX trended down to 163 after 6mo HRT from a high of 793 at end of Forteo treatment, a change I didn’t anticipate at all.
Any comments or analysis are welcome; and best luck to us all no matter what therapy path(s) we choose!
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Or simply interview the doctor and ask about their education, expertise and length of time in treating patients with those needs. It's like a job interview....what qualifies you to treat my _____fill in the blank.
Unfortunately, the Women’s Health Initiative back in the early 2000’s influenced physicians to not use HRT for post menopausal women. I believe many women suffered after this flawed study and there are still physicians out there that have not updated their knowledge base. Very frustrating for women and my hope is that my daughter and granddaughter will have better care than I do as they age. I feel like I am fighting with my rheumatologist and gynecologist. Have an appointment with an endocrinologist a few counties away, but it isn’t until 2026 he is so busy. Hoping I can stay stable until then.
Any functional medicine providers in your area?
Curious to know what your docs give as their rationale for denying bhrt.
I have not found anyone in a two county area who believes in bhrt. Granted, I have not had appointments with everyone. But I have talked to many women in my area who are in the same pickle and running into this brick wall. The rational I have received from all of them is cardiovascular risks. My father suffered from heart disease and had a heart attack at age 51. He was an athlete. My mother had deep vein thrombosis in her mid forties and then suffered mini strokes as she aged. I believe they see me as high risk for a cardiac event; specifically based on that flawed study. To that point; to date I have no heart issues. I’ve always been active; no high blood pressure. So in conclusion, I think they fear liability.
@gravity3
One last thing, I believe my current physicians are pressured by the insurance companies as well.
I've come to similar conclusions.
Wow, you've done a fair amount of work for an informed and shared decision.
I've only done LPa for ASCVD genetic testing, and thought APO-E is for neurodegenerative risk. My understanding is LPa and APO-B are most atherogenic where high LPa is not treatable. But since LDL-c is routinely tested it became the "proxy" for atherogenic burden although for some people the two may not correlate to each other. Please correct any misunderstanding here from your knowledge base.
Which calculation method do you use for your 10 year cvd risk? I've used MESA which takes cac score into account. The calculated risk is below 2%. But this calculated risk is based on the LDL-c level that was controlled below target value by a statin and heart healthy diet. I have a feeling cardiologists know this very well based on labs/tests, medical history and family history.
You are at a unique position to use HRT for your osteopenia to prevent/stop bone loss. I wonder how often you get dexa scan and if you monitor bone markers. I'm keen to see how testosterone in the mix would affect bone markers. If you test them and could share, it will be great to to observe testosterone effect, even at the very low dose you are getting,