Mild osteoporosis DEXA scores: what would you do?

Posted by prettyflower @prettyflower, Jan 8 9:46am

I posted this question earlier, which was about mild vs. severe DEXA scores. Replies seemed to veer off pretty quickly, lol, so I'm starting again. My last DEXA in May 2023 was a -2.7 spine, and during a surprisingly quick appointment a new doctor (an endo) said to go with Prolia. Background: I had been on Fosamax for over 4 years based on a -2.5 score. I had an initial slight improvement then it dropped to the -2.7. After reading quite a bit on this forum and elsewhere, I don't think my scores warrant Prolia. In fact, I've decided not to go on any medication until May of this year, when I will pursue another DEXA on a TBS-equipped machine. I will consider it my new baseline. My last two DEXAS were on different machines. What are your thoughts about scores, and when it becomes really necessary to treat with meds? Would anyone else here approach it as I am, by waiting a year for another DEXA with TBS?

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

@lamay

Thanks for mentioning HRT, I'm also curious. It was never brought up to me until recently except to scare me away after the WHI study. I've heard you can't take them after 59, or 10 yrs past menopause. I'm 57, seven years past menopause, -2.6 femoral neck. If I tried HRT would I have to stop in two years and my bone density would drop? I.e., does it give any lasting benefit or only delay the inevitable by two years?

Jump to this post

I started 13 years past surgical menopause and will stay on rest of my life with blessings from cardiologist, oncologist, and Obgyn. Had I started sooner, might not have needed Tymlos. I started hormones one at a time with two weeks in between to look for any negative side effects. Estrogen, Progesterine, and Testisterone, all bioidentical,

REPLY

I did the diet and exercise, pt approach and my dexa improved 20% in one year, still osteoporotic, but I still fractured. I am now on bioidentical hormones that I wish I had started long ago, including testosterone. My hips are worse than spine, even though spine fractured, so I’ll be taking hrt concurrently with Tymlos. Hrt protects hip, since Tymlos, on dexa can initially lower. All this said, my mom was on oral eatrogen alone for 30 years and still had three spine fractures, hip and pelvis. Diet, exercise, and meds!

REPLY
@sallyj2

Yes and yes! I wish I had too! Obgyn recommended, bio identical, endo said no, bad info, based on outdated studies.
I’d love to know what doses hrt you’re using to maintain! I’ve read so much. Easier to find dosing for estrogen than testosterone. Really frustrating.

Jump to this post

I was on .025 transdermal estrogen. That is the lowest dose and it has been shown to maintain density. After 5 years, I recently increased to .0375. I am currently seeing a menopause specialist and she wanted me to go to .05 but I was reluctant as I was concerned about the potential for breast tenderness and enlargement so I compromised with .0375. She felt that the slightly higher dose would provide a greater benefit. I've had no body changes or side effects on the new dose. It is still considered a very low dose. I have looked into testosterone and at this point, it seems that it is not recommended for women except in the case of low libido. There is little to no research on women taking it for osteoporosis. In addition, testosterone is processed and converted to estrogen so personally, I am not comfortable taking it and was recommended against it by my menopause specialist who has been prescribing HRT for decades.

REPLY
@teb

It would be an option for you to explore. There are risks in taking any medication whether they are osteoporosis meds or hormones so you have to decide which risk you are most comfortable with. There's also the "do nothing" or "diet and exercise" approach which risks further bone loss and fracture. These are really tough decisions for each of us to make. Personally, I chose pharmaceuticals that I felt were most "natural" to the body after a failed diet and exercise approach led me to go from -2.8 in my spine to -3.2. I knew I needed a bone builder at that point and since Forteo was synthetic parathyroid hormone, and mostly built spine where I had all of my loss (typical of bone loss progression, from spine first to hip secondarily), I felt that it was something the body was accustomed to and recognized. The same with hormones. I am replacing something that was natural to my body and that maintains bone in a natural way so I chose that after Forteo to maintain the gains. Hormones were once readily prescribed for osteoporosis but that changed after the results of the WHI study were widely publicized and vastly misrepresented. You can still get a prescription for HRT from your gynecologist for "menopause symptoms". If they are reluctant, you can use an online service such as Alloy Health if you are in the USA. They have MDs on staff who are menopause specialists and will evaluate your situation and prescribe a dose they feel is appropriate. You do this all by email. There are no fees unless you chose to proceed with a prescription and then you are charged for the medication only. If you want a more in-depth consultation with a physician, that is available for a $35 fee and is done through private messaging on their website. The lowest dose of transdermal estradiol is .025 which is also considered the safest and is a dose that is likely sufficient to stem bone loss. I was on that dose for 5 years. I've had only the slightest loss in all that time so I just increased my dose to .0375 as a further safeguard. If you have a uterus, you must be on progesterone as well and the safest option is bioidentical progesterone, not synthetic progestin. The typical dose prescribed is 100 mg oral.

Here are some options for you to read further:
Estrogen Matters by Dr Avrum Bluming
https://evidence.nihr.ac.uk/alert/risk-of-breast-cancer-with-hrt-depends-therapy-type-and-duration/

Jump to this post

Thank you so much @teb. This is all relevant to my situation, as is your noting that hip scores tend to fall after spine. I will use your information while proceeding.

REPLY
@teb

I was on .025 transdermal estrogen. That is the lowest dose and it has been shown to maintain density. After 5 years, I recently increased to .0375. I am currently seeing a menopause specialist and she wanted me to go to .05 but I was reluctant as I was concerned about the potential for breast tenderness and enlargement so I compromised with .0375. She felt that the slightly higher dose would provide a greater benefit. I've had no body changes or side effects on the new dose. It is still considered a very low dose. I have looked into testosterone and at this point, it seems that it is not recommended for women except in the case of low libido. There is little to no research on women taking it for osteoporosis. In addition, testosterone is processed and converted to estrogen so personally, I am not comfortable taking it and was recommended against it by my menopause specialist who has been prescribing HRT for decades.

Jump to this post

I’m on .5 transdermal- 50/50 mix estradiol/estriol. And, will lower if I need to. Trying low dose testosterone every other day. It does help build muscle It is used in Australia and GB.
Thanks and good luck!

REPLY
@rjd

I think the original poster subsequently posted that the endocrinologist advised her that HRT was not an option. Perhaps as a first step, the basis of that medical opinion should be fully understood.

Jump to this post

I agree with that very much @rjd. (original poster here)

REPLY
@southcarolina

What doctors have you seen and where are they located?

Jump to this post

I am in Louisville, Kentucky -- a hospital town and health education hub. I was put on Fosamax by my PCP, and she referred me to an endocrinologist who wanted Prolia. That's it. I tried to get an appt with a rheumatologist within my network who had advertised as an osteoporosis specialist, but when I called I was told that the practice "no longer treated for osteo". I was shocked. There is just no specific path of care.

REPLY
@teb

I was on .025 transdermal estrogen. That is the lowest dose and it has been shown to maintain density. After 5 years, I recently increased to .0375. I am currently seeing a menopause specialist and she wanted me to go to .05 but I was reluctant as I was concerned about the potential for breast tenderness and enlargement so I compromised with .0375. She felt that the slightly higher dose would provide a greater benefit. I've had no body changes or side effects on the new dose. It is still considered a very low dose. I have looked into testosterone and at this point, it seems that it is not recommended for women except in the case of low libido. There is little to no research on women taking it for osteoporosis. In addition, testosterone is processed and converted to estrogen so personally, I am not comfortable taking it and was recommended against it by my menopause specialist who has been prescribing HRT for decades.

Jump to this post

Thanks for this. I've heard same about testosterone. I highly recommend the Vajenda by Dr. Jen Gunter, she has a lot to say about unregulated bioidentical hormones, and testosterone.

REPLY
@lamay

Thanks for this. I've heard same about testosterone. I highly recommend the Vajenda by Dr. Jen Gunter, she has a lot to say about unregulated bioidentical hormones, and testosterone.

Jump to this post

I'm not familiar with her and will take a look at her site. Dr Mary Claire Haver is also a wealth of information, presenting results of scientific studies in an easy-to-understand manner.

REPLY

I am 72, living in NE KS. I have all my parts intact, have never been on HRT. Recently had a DEXA scan: Spine - mineral density of 0.975 grams/cm squared. This is a T-score of-1.8. Femoral necks - demonstrate a bone mineral density of 0.628 grams/cm squared. This is a T-score of-2.9.
My primary mentioned treatment with prolia or fosamax, but was unclear as to any side effects, etc.
He never mentioned HRT.
Does anyone know of a specialist of any kind in this area (NE KS, KC, or NW MO) I could see about guidance and advice?

REPLY
Please sign in or register to post a reply.