I recently had an OB-GYN say to me in a very irritated tone, “You’re the third patient this week who says they’re on HRT for osteoporosis! It’s not a treatment for osteoporosis! It might help, but there are other better treatments for osteoporosis!” So there’s that. I’m not staying with that OB-GYN BTW. Found a much better and more supportive one who said she has patients in their 80’s who are on low-dose HRT and they’re doing great. I’m due for a Dexa scan and I guess I’ll soon find out whether the HRT and Vit D have made a difference at all.
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Not ok for a doctor to have a very irritated tone, but what they said is not incorrect. People have to do what’s right for them. For some, they don’t want to take the risks of even low dose HRT, while others see it as a non-issue and/or they are willing to accept the trade-offs.
I just saw my ob-gyn and we talked about calcium supplementation (I have osteopenia.) You have to pick your poison…high calcium can contribute to/increase plaque in arteries, so I only take a calcium supplement maybe once or twice a week because my calcium levels (and D levels) are always in range. Said differently, I will take osteopenia to osteoporosis risk before I take cardiac risk. It’s actually with my PCP that I’ve worked thru all of this, and my ob-gyn supports the plan.
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I’d worry about the breast cancer risk with HRT and can see why an OB/GYN would care about that before caring about bones and opine there are other things might be a better first course. A bone doctor may care first about the bones and less so about plaque or cancer. A dentist will have his own priorities too.
I have a friend who did an HRT program years ago and when she got breast cancer it really limited the drugs they could give her so she regrets the HRT treatment (she has to take a much stronger drug for estrogen suppression because the HRT never cleared her system).
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This also happened to my mom. On top of that, she had serious issues from Fosamax. Oh, and I have my own minor issues that limit the use of supplements. Sometimes it’s pretty darn complicated to manage my health with all the competing issues that impact treatments.
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Yes I know. HRT is not what’s offered for osteoporosis. I think I’m just bummed because SO many of my friends who are 2-3 years younger started HRT in perimenopause and I did not. Seems like it’s become more popular lately and not so much when I needed it seven years ago. The drop in estrogen is likely what’s causing my bone loss. Maybe that ship has sailed for me.
As for calcium supplements, my endocrinologist said to max out at 1200 mg per day but my blood test results from last August (before I was taking any calcium) had me in the normal range so I don’t know why she wants me to take so much. I might back off a bit. When I asked about the effects on heart health, she scoffed.
Last, I just read to not take your calcium supplements for two days before taking a urine test checking for calcium and she didn’t tell me that!
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HRT was hot when my mom went through menopause. It’s not a magic cure. The reasons it fell out of favor were important reasons why I chose not to consider it. It’s not without its serious drawbacks.
Many doctors operate in their own silos.
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HRT might be good for prevention, but I have been told it’s effect is not strong enough to reverse significant osteoporosis.
Some doctors express frustration at people’s resistance to meds.
I had significant osteoporosis with fractures and Tymlos brought me to borderline, a few months of Evenity and low dose Reclast brought me to osteopenia. I had hormonal breast cancer so I am glad I didn’t do HRT: I would have blamed myself!
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I did Evenity for a year. That seems to me the practice around me.
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@bookworm did you follow up with Reclast?
I can’t do anything yet. I’m dealing with a dental issue.
Someone I know well continued with PROLIA
You probably know this but Tymlos and Forteo do not affect dental issues. But there can be insurance issues if your osteoporosis is not severe enough. Those meds actually build new bone. Prolia, Reclast, Fosamax affect turnover. If you are income qualified, Tymlos and Forteo can be free, and not involve insurance.
Thank you for detailing your osteoporosis treatment. Following your Tymlos/Evenity/Reclast series, did you follow up with any other med or are you currently on a break?
If on a break, can you stay off meds until your numbers drop again? I was under the impression that once you got on the meds merry-go-round, it was difficult to get off.
I am doing Tymlos again. I will check a DEXA soon to see if it is working. Then low dose Reclast for maybe two years. I get a CTX blood test to see if the low dose is working (I do a 20% dose, twice in a year to miniimize side effects due to some heatlh issues). Then yes a break until treatment is needed. After all these meds I will again talk with Keith McCormick, the chiropractor expert on osteoporosis who did Forteo then Fosamaax for his own fractures. He wrote “A Whole Body Approach to Osteoporosis” and more recently “Great Bones” which covers natural and medical approaches. My doctors have been willing to discuss unusual protocols and I am grateful.
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well, I think I had every blood test possible to find a cause for my osteoporosis and did the 24 hour urine test as well. Kidney function good. Calcium in blood normal. Thyroid fine. No celiac. The calcium in my urine was in the normal range but on the low side and I was also normal but low on D in my blood test, so my doctor suggested that a main contributor to my osteoporosis.
As a reminder, I was at -2.5 for femur and -2.7 for lumbar spine and I’m postmenopausal, 58 yrs old and white and thin. I’ve always been a runner but not excessive, maybe 25 miles per week and have done pilates reformers work out for years and some free weights. I have been taking a calcium supplement since my DEXA scan about 9 months ago. 1200 mg a day and then 2000 IU of D. I did not take the calcium/D the day before I gathered the urine but she didn’t think that mattered.
Doc said I need to up my calcium and D and take twice as much of both. It is true that I have not focused on calcium for years and years. I’m lactose intolerant and never drank milk. I do have Greek yogurt for breakfast every day and maybe a slice or two of cheese on average per day and I eat my fair share of spinach and broccoli but certainly not every day. I know I’m not getting enough through my diet.
Of course the doc isn’t a cardiologist and isn’t concerned with calcium/heart issues. I’ve read conflicting reports on that. For now, I’m just going to do as she suggests. I was supposed to meet with her again in a few weeks but I now have a conflict and can’t make that appointment and the next time I can get in is in March lol so I guess I’ll just see her then. She wanted me to get another DEXA this summer which would be just about a year after my first one but I’m going to wait until next summer and see if the calcium, D and lifting heavier weights makes any difference.
Was your calcium that low on the blood tests? Doubling it seems like a lot of calcium and D.
I know. I think so too. I’ve reached out to my doc to ask why the big increase when I can’t find anything saying that much calcium has an effect on osteoporosis. My calcium blood level was right in the middle of the normal range.
@homerdog first of all you are barely into osteoporosis: hope that is reassuring. You might want to consult with Dr. Keith McCormick or pick up one of his books (mentioned above): “A Whole Body Approach to Osteoporosis” and “Great Bones” which is more recent. He also does consultations. He knows a lot about nutrition since he is a chiropractor.
I am curious what kind of doctor told you to double calcium. I have been told/read that the body only absorbs 500mg at a time. I had severe osteoporosis but only take 800mg/day and I am not able to have dairy so very little from diet. My levels are fine. I think it is very individual.
For Vitamin D, if you are low, obviously you want to take a lot to get the levels up but then you need to figure out what maintains that level. Vitamin D levels that are too high can be toxic. I generally take 2000 in the winter and 1000 in the summer, in the Northeast. Again a lot of individual variation and it also depends on where you live.
In my view and experience, menopause alone can be the culprit for the onset of osteoporosis. The loss of estrogen has that effect. It is wise to look at other contributing factors and also at what might help mitigate bone loss, but I believe for most of us some bone loss is inevitable. We are living a lot longer than people used to!
With your bone scores a doctor might recommend a bisphosphonate or Prolia. I hope you will read McCormick’s book and/or talk with him or another provider who is good with natural approaches to supplement and endocrinologist you might ultimately see. Meds are life saving for me but with your scores I might try to do alternatives to meds!
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thanks. This doc is a well-known endocrinologist in the Chicago area who came highly recommended and I had to wait eight months just to get in for my first appointment! Yes, my D is low so I will increase that. She was concerned about my urine calcium, not my blood calcium which was normal.
We exchanged a few messages and I told her I’d rather try to get more calcium from food instead of increasing supplements. She said that’s fine but try to top out at 1200 mg for food and then continue 1200 mg supplement. She didn’t suggest any other meds for now. I’m trying to get a hold of McCormick’s book and I’m second on the waitlist now from the library so I’ll get it soon! I am not going to do Prolia for sure. Really not interested in a biophosphanate either quite yet and maybe never.
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After my first bone density test, they said I have osteopenia. Not surprising as I’m a fine boned white woman.
2 years later, I changed nothing except I consistently took calcium supplements and vitamin D. I’ve always been pretty active, I continued doing what I do.
My bone density improved
I’m going to figure that the change in supplements made a difference. Don’t want to open a can of worms but I wonder why the resistance to supplements. I understand that getting more calcium through diet is better but I guess I’m confused why not supplements to the diet.
My mil won’t take supplements, that’s why I’m asking. She has a broken pelvis despite being on prolia. Not that taking calcium would have changed anything, I have no idea.
I have my next bone density test next month. Hopefully things won’t have changed. But if they do, I’ll probably take the advice of my physician.
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for me, it’s because calcium pills are HUGE, horse pill size. I take other pills morning and night and they are just HUGE. I tried the chocolate chewable ones but didn’t really like them either.
For me,it is a ‘just in case’ pill so I resist.