Osteoporosis after broken ankle

I'd probably defer to your doctor on when you can start doing exercises that will promote bone health. While I took Fosamax years ago and still have residual improvement from that medication, yoga, walking and taking vitamin D and calcium supplements(not sure if these really help) have maintained and improved my bone density scores. Good luck and hope your ankle heals quickly!

Your doctor and a physiotherapist should be able to guide you on which exercises you can do safely with your healed fracture. Can you get your doctor to refer you for physical therapy? They'll do an assessment and work with you on exercises you can do.

This is what I did after my vertebral compression fracture. It took quite a few months but I am back to my pre-fracture workout routine and feeling stronger every day.

I got the referral today. I am going to start with physical therapist who specializes in osteoporosis. I am thinking about starting HRT to try to hold my numbers in place for a bit. I talked to PCP about it. She will prescribe it for me, but she does not know the dosing to promote bones and neither do I. I'm glad you are back to your prefracture routine. I still have a ways to go.

I have the prescription for 0.025 mg estradiol patch and progesterone. I felt pretty sure before, but now I'm feeling scared. I would like to hear from anyone who had success using HRT to prevent further deterioration with their T-Scores. Is this worth the risk? I am 57.

Thank you for your encouragement. I have an appointment with a physical therapist who specializes in osteoporosis, and I'm probably going to try HRT. It is all a bit overwhelming. It feels like starting with the broken ankle on January 1st, this year has only been pain, surgery, bad test results, and doctor visits.

You are at a good age to consider starting HRT, especially if you are within 10 years post-menopause. 0.05mg/day estradiol patch (or equivalent dose in other dosage form) is considered as the "standard" dose used for osteopenia and osteoporosis. However, some studies suggest that a lower dose - 0.025mg/day patch - can also be effective. A few members on this forum, myself included, are currently using this lower dose.

One way to gauge the effectiveness of HRT before your next DXA scan can be by testing bone turnover markers like CTX and P1NP. However, keep in mind that your CTX or P1NP levels might still be slightly elevated due to your recent ankle fracture.

In my case, I started HRT after completing Forteo. I've been monitoring bone markers and had a DXA scan 6mo after beginning HRT, which confirmed that the low dose was adequate for me and that my bmd remained stable (actually had further improvements).

In the absence of a secondary cause for osteopenia or osteoporosis, estrogen therapy is likely to prevent, or at least slow further bone loss. Past studies have shown an average improvement of 2-4% in bmd after 1-2 years of using transdermal estradiol.

Thanks Mayblin. It is reassuring to hear that you were able to maintain and possibly gain bmd with HRT, and I appreciate your help with the dosing. Do you have any thoughts about the breast cancer issue? I know it is lower than originally thought. I saw a study in the Lancet from 2019 that stated the risk after 5 years was an extra 14 to 20 cases per 1,000 women. (The forum prevented me from posting a link.) I know all medications have risks. I just had never planned to use HRT until last week.

And thanks for pointing out that the CTX and P1NP might not be accurate for me right now. I have not researched those tests yet, and I would not have thought of that. I want to test for celiac disease soon just to make sure that is not causing this issue.

Hi Nikita,
I broke my ankle in August 2023 and broke my shoulder in February of 2022.
I had also been having issues with Menopause when my gynocologist asked me why I didn't go on HRT. She said the chance of breast cancer was overblown and there was additional evidence suggesting it actually had many advantages especially if I had Osteoporosis. I went on it In January 2023 when I was 56 and after lowering the dosage a bit -it has been amazing. There is a lot of misinformation regarding HRT and breast cancer. It IS definitely worth the risk. Read up on the newest information first though.

You're likely referring to this article from The Lancet:
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(19)31709-X/fulltext
As you pointed out, the conclusion from this meta-analysis showed a higher estimated risk of breast cancer compared to some other publications. However, the analysis was based on pooled data across all types of menopausal hormone therapy (MHT), with synthetic progestin -specifically medroxyprogesterone acetate (MPA) - making up thr majority of the data set, likely skewing thr risk estimate upwards.

The current preferred HRT/MHT regimen among obgyn is transdermal estradiol, combined with oral or vaginal micronized progesterone for those with a uterus. However, studies or meta-analysis focused on this regimen are very limited.

According to this review paper https://pubmed.ncbi.nlm.nih.gov/29384406/ , " estrogens combined with oral (approved) or vaginal (off-label use) micronized progesterone do not increase breast cancer risk for up to 5 years of treatment duration". When used for more than 5yrs, etimates of the absolute risk (for transdermal E2) might rise by 0.5-1% over 10 years compared to non-users, but is not statistically significant in most studies.

https://journals.lww.com/menopausejournal/fulltext/2024/05000/use_of_menopausal_hormone_therapy_beyond_age_65.3.aspx : this paper, based on very large prescription database, includes an interesting breakdown of health outcomes - such as breast cancer - by hrt type, route and dosage. While you are not in the same age cohort, I thought it's worthwhile to take a look.

I’d also like to add, @nikita606, that I had a full risk assessment for both breast cancer and cardiovascular disease before starting HRT. I sought second opinions as well. My OB/GYN, who is prescribing the therapy, has said I could continue it for life unless future health conditions suggest otherwise. My primary care physician though, recommended limiting use to no more than five years. I plan to make ongoing decisions based on emerging data and new clinical guidance.