HRT Safety

@mayblin , I am so excited to share my CTX results from five days ago. My CTX result in May, 2024 was 688. The result today, April, 2025, was 138! That's about an 80% decrease! I began HRT (.25 Estrodiol patch and micronized Progesterone 100mg) in July of 2024 and have been taking Keith McCormick's recommended supplements since December of 2023. I mentioned previously that my REMS Echolight spine T score went from -3 in April 2024 to -2.6 in February 2025. I was hoping to at least stop the progression of loss, so this improvement was a bonus. My total hip Echolight T score went from -2.6 to -2.3. The Echolight shows my fracture risk to be on the border of low/moderate so reasonably good bone quality still. The next test will be another DEXA with TBS I am waiting for. My worst DEXA T score was spine -3.5 in November, 2023. I am hoping there will be some improvement on the DEXA as well and that the TBS shows reasonably good bone quality. It is so encouraging and empowering to get this CTX result without heavy medication.

I forgot to mention my ALP liver enzyme lab result just received. The ALP level is determined by liver or bone activity as I understand. I first read about this in Keith McCormick's "Great Bones" If the ALP result is high, the cause could be from liver or bones. My ALP has been high for a few years at around 120 U/L -- the range 35-105. I suspected my high ALP might be due to my OP and high bone turnover rate. A follow-up Bone Alkaline Phosphatase test must be done to confirm either bone or liver cause. Along with my 80% decrease in CTX level, my ALP dropped from 120 U/L to 45 U/L for the first time in years! I strongly suspect the cause of elevated ALP levels was from my bones though would require a BALP to be 100% certain.

This is awesome @debbie1956! The reduction in CTX is phenomenal. This paper published long time ago showed that a greater than ~55% reduction of CTX after 6mo estradiol patch is correlated with a positive bmd response at 2 years:
https://pubmed.ncbi.nlm.nih.gov/10831925/
Your ALP changes over time is interesting and confirming the information that we knew. Mine almost doubled from pre-tretament of Forteo to 13mo with Forteo. Yours went the other way. As you suggested, the reduction in your ALP could be indicative of a downturn in bone formation which is best confirmed by bone-specific ALP. Curious, were your other liver enzymes such as ALT, AST and total bilirubin all within normal range during the period you had 'abnormal' high ALP?

Your results also confirm that transdermal estradiol patches, even at a low dose, could suppress CTX to this level. Well, at least for both of us 🙂 . When I first saw my CTX result, I was thinking that I might have a low baseline (which I did not have) to start with. Now I don't really need to second guess estrogen's power. Thanks Debbie.

What is ctx

@tiny28 CTX is a blood test that measures osteoclastic activity which is the breakdown of old bone. Here’s an official definition:

Serum cross-linked C-telopeptide of type I collagen (CTX) is a marker of osteoclast activity and is used to assess the level of bone resorption.

Thank you . My rheumatologist only did the basic tests . Calcium Parathyroid etc. are there any other bloods she should have done as it’s a mystery to me why my osteoporosis is so bad when my bloods are so good and my lifestyle etc is good . I would appreciate your thoughts

I’m happy for your success! Thank you for sharing your amazing results. Would you mind sharing which supplements McCormick suggested you take?

The supplement list is a long one. I haven't consulted Keith McCormick directly. You can read about these in his "Great Bones" book to see if they would apply to you. I wouldn't suggest everyone needs to take all these. I also have autoimmune, cholesterol, prediabetic and triglyceride conditions, so take some of these for these conditions as well: Collagen, K2 MK4 and MK7, magnesium, calcium Boron, Alpha Lipoic Acid, Curcumin, Resveratrol, Berberine, Simply one 50+ multivitamin (contains high vitamin D), N Acetyl Cystein, Acetyl L Carnitine, Calcium Hydroxyapatite. CoQ10. My naturopath physician concurred that these supplements would support my needs. I follow McCormick's and my naturopath's diet recommendations for high protein (including whey and pea protein powder), leafy greens, nuts, fruit, cheese, Greek yogurt and milk etc. Sorry for the long list! It is difficult to be certain of how big a role my diet and supplements played in lowering my CTX level, though Keith McCormick sites several cases of his patients who lowered their CTX through diet and supplements he recommends. I have no doubt that the HRT played a large role in lowering my CTX.

@tiny28, I'm surprised your rheumatologist only ordered the calcium parathyroid test. What about the 24 hour urine calcium? However, even if this test is normal, the calcium may still not be reaching your bones as explained in "Great Bones". You can find all the recommended tests in Keith McCormick's "Great Bones" book.

Thank you. In England it’s hard to find a decent rheumatologist. I have tried three! However I will demand more testing and read the book.