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Femoral neck -2.8: Would you start treatment now?
From Osteopenia to Osteoporosis in Five Years - what would you do?
Hi everyone, I'm 57 and was recently diagnosed with osteoporosis after progressing from osteopenia over the last five years.
My 2026 DXA results are:
Left femoral neck: T-score -2.8 (osteoporosis)
Right femoral neck: T-score -2.3
Total hips: -1.7 and -1.9
Lumbar spine average: -1.2 (although I'm investigating whether this may be masking more significant bone loss, as L4 alone is -2.2)
My previous scan in 2021 showed a lowest T-score of approximately -1.3, so the drop to -2.8 has been a shock. I went through menopause without HRT, had a demanding job, did very little exercise, and paid little attention to bone health. Although my doctor knew I was menopausal and had osteopenia, I wasn't aware how much bone loss could occur during this period. I have seen my doctor and am being referred to a specialist. MHT/HRT and osteoporosis medications have both been suggested. I am now about five years post-menopause. I don't have menopausal symptoms such as hot flushes, and my main concern is bone health.
My dilemma is deciding whether to:
Start MHT/HRT now and see whether it helps protect bone.
Go directly to osteoporosis medication.
Spend 12 months focusing on exercise, nutrition, calcium, vitamin D, and strength training, then repeat the DXA before making a treatment decision.
I am also concerned about the long-term commitment involved. MHT may be reasonable for five years, but I'm uncertain about the balance of benefits and risks beyond that, and I've read about the potential for bone loss after stopping treatment.
My questions are:
Has anyone started MHT/HRT around five years after menopause primarily for osteoporosis?
Was it worthwhile for your bone density?
Did anyone choose to monitor and focus on lifestyle changes for a year before starting medication?
If you had a T-score similar to mine (-2.8 at the femoral neck), what treatment path did you choose and why?
Looking back, would you make the same decision again?
Thank you. I'm still coming to terms with the diagnosis and would really appreciate hearing about other people's experiences.
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I’m soon to be 76 female , no fractures yet, seeing an endocrinologist, only took A serm Evista when I was 50 years old which did slow down bone loss).
Upped my exercise program focusing on hip and spine, like squats, fire hydrants leg moves, lunges, lay flat prone and lift head,legs,arms(didn’t remember name) garden, dancing, Pilates, yoga, swimming . Taking supplements that help bone density K4, Magnesium, D3, liquid fish oil. Native Path brand for Fortibone (almost 2 years Reduced wine intake, hardly have any sugar as I skip deserts. Xylitol (supposedly helps increase bone density) in coffee. Instead of getting Dexa Scans which prove to be faulty information (even results vary on same day, same technician, and same machine, and radiation which is also not great for bones).
I’m paying out of pocket Ultrasound REMs scan more often to show bone density and bone quality and NO RADIATION. My next one is in November and will see if anything has changed.
Once you start medications you’ll continue to take them with holidays and change of meds. Should I have a fracture I might consider taking them but for now I’m avoid them.
My mother had bad Osteoporosis, never broke any bones, never exercised, ate poorly, but apparently when she did fall took it well!
Anyway I’m still researching to avoid starting any medication.
My femoral neck is -2.5.
@strongbonez I was on Fosamax for just over five years. I had reasonable gains for the first two years, was stable through 3 years then my T-scores started declining in years 4 & 5. During this time, my PCP was managing my treatment.
Just after my fifth year on Fosamax, as I was preparing to take a "holiday", I had a compression fracture at T8 caused by bending over a bathtub and placing a lot of pressure on my rib cage. It didn't even occur to me that it might be a fracture as I have worked out for years and had occasional back pain. When it didn't get better after three months, an x-ray was ordered and a healed fracture of "indeterminate age" was reported.
After that, I stopped the Fosamax and was sent to a rheumatologist who performed a few basic blood tests and prescribed Tymlos. My insurance company cut me off after four months and made me take generic teraparatide which gave me severe constipation that was unrelieved even with laxatives. I chose to go off it at that point and asked my PCP to refer me to an endocrinologist affiliated with Stanford who specializes in osteoporosis.
She prescribed Evenity, which I took for 12 months. I just had my first Reclast infusion yesterday. She was the one who discovered the hypercalciuria. I feel like I am good hands now with her.
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1 Reaction@oopsiedaisy thank you so much for sharing your journey with me! It's very helpful to hear what medications you have used and your results. So glad you are now with an endocrinologist who you feel comfortable with.
My endocrinologist has recommended Prolia followed by Reclast. I just feel like it's a cookie cutter response he could give to any of his patients, so I would appreciate hearing how things go with you and the Reclast.
I hope it goes really well for you. We could all use a little good news when it comes to medications for treating osteoporosis!
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1 Reaction@oopsiedaisy
Like you said, side effects are real and affect everyone differently. I am under a Gi care for constipation now, let alone if I start meds. How was this handled as a real side effect for you and how was it managed or did you just stop the meds?
@michaellavacot Thank you, that's really helpful. I hadn't really considered that the goal might be not only slowing further bone loss but also rebuilding some of the bone already lost. Part of my hesitation is wanting to make the best long-term decision rather than rushing into a treatment pathway without understanding the likely benefits and trade-offs. Can I ask whether HRT and anabolic treatment were offered because of your T-scores, fracture history, or some other risk factor? I'm still trying to understand where someone like me (57, one femoral neck at -2.8, the rest in the osteopenia range, no fractures, low FRAX) fits on the treatment spectrum.
@oopsiedaisy Thank you for sharing your experience and for pointing out the size of the drop. I found my previous DXA report and my left femoral neck BMD appears to have fallen from 0.780 g/cm² in 2021 to 0.592 g/cm² in 2026 (about 24%). The scans were done on the same scanner model, although at different locations. I'm not sure whether it was the same machine, but I don't think that alone would explain such a large change. I hadn't heard of hypercalciuria before, so thank you for raising it.
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1 Reaction@meri8181 Thank you for sharing your experience. It's encouraging to hear from someone in their mid-70s with a femoral neck T-score similar to mine who has remained fracture-free and medication-free. You have clearly put a lot of work into exercise and lifestyle measures over the years. My challenge is that my left femoral neck appears to have dropped by about 24% over five years, and I'm only 57. Can I ask what your femoral neck T-score was in your late 50s? Has your bone density remained fairly stable over the past 20 years, or did you go through periods of more rapid bone loss?
I am due also. More than likely I have declined. Last year I struggled with sciatica and didn’t do much nor did I choose an epidural. It does act up but with support therapies it’s manageable. Now I have a partial tear in the meniscus. No not a break just degenerative. PT says it’s common. I’m in the gym taking classes have a trainer in aqua aerobics , will start Fortibone. Much to the potential annoyance of the drs I will request to postpone until early next year. Don’t know how they will react and if I am making the right decision. I want to get my other medical issues in order first, but again it may be making the wrong decision. And you?
@ipg
I wonder if you would be more confident in your decision making if you had a dexa scan to see if there is a decline and if so, how much?
@gravity3
I’m sure you are right.
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