HRT for bone health

[JustAMiddleAgedDirtBagBaby]

I have a strong family history of osteoporosis, and protecting my bones is one of my motivations for starting HRT. Other physical peri symptoms have been fairly minimal and those I have are easing since starting. My main peri symptom has been anxiety and I'm aware that HRT might not do much for that.

I'm on evorel 50 patches and the mirena coil. I haven't had any blood tests and my understanding is that they aren't that useful as they're a snapshot.

Does anyone know if there's a dose of estrogen I should be aiming for if bone health is part of my reason for starting HRT.

Following as I would be interested in knowing too.

https://www.menopausematters.co.uk/postmeno.php

There is a * beside the types that are licensed for osteoporosis @JustAMiddleAgedDirtBagBaby

There is no 'set' dose as all women respond differently but even very low doses do have some positive effect. There is evidence that low doses of 1mg or even less have some effect. 50mcg patch is a medium dose (patches go down to 25mcgs.)

What you need to do is have a DEXA scan now and then one every 2 years. If your bones are losing density on the dose of HRT you might want to increase it.

My local health board only does dexa scans if you've had a fracture unfortunately - which I have to say I think is a massive false economy given how expensive falls and fractures are to the NHS.

@JustAMiddleAgedDirtBagBaby you can get them around £200 at private hospitals.
If I were you I'd choose to do that.

You can ask your GP for a dexa scan but they sometimes seem reluctant. My family has an extremely strong history of osteoporosis and my sister was getting noticeably shorter (mid 40s). The GP did a blood test which showed her calcium was fine and on that basis wouldn't send her for a dexa scan at least until she's in her 50s. She's not on HRT and is just trying to keep her calcium & vitamin d up naturally.

I had chemo and high doses of steroids 2 years ago, and that combined with the family history was enough for my (different) GP to send me for a scan. It was fine, although I had been on lots of calcium & vitamin d throughout my treatment. I am on HRT because of early menopause at 44 (caused by chemo), partly because of concerns about my bones but I also had terrible hot flushes. I started on the equivalent of Evorel 50 but increased to twice that dose to control the hot flushes. The Drs seem to use the symptoms as a barometer for the bone health (I.e. if the hot flushes come back, I must need more oestrogen, therefore a higher dose would also be beneficial for my bones) - my GP is not particularly clued up on HRT though.

So, depending on your age you could ask for a dexa scan if you're worried, and checking your calcium & vitamin d levels might be worth it.

Is it possible to have DEXA scan privately? It would be really useful for you to know.

@JustAMiddleAgedDirtBagBaby If you mum has osteo it's possible you can get a DEXA scan based on family history. Otherwise the NHS is pretty useless on this and only tends to act when it's too late.

However, private ones are around £250 and only need doing every 2 -3 years ( NHS says 5!) so cost per week is pretty low, if you spread that over 2-3 years.

Put your town into google and search DEXA scans. many private hospitals do them and if you're near London there are loads of private clinics doing them.

I'm interested in this too, I'm not having too many issues with menopause so I'm not on HRT but the bone density aspect of it concerns me. If I get a private DEXA scan who analyses the reading? Do I then need to take it to a GP, or a menopause specialist?

My grandmother had it, my mum had it and my older sister was diagnosed with it at 63. (But she had an early menopause at 44 whereas I am still going at 50)

Nearest private provider is three hours away - and twice the price of London clinics, which are five hours away. I am willing to consider private but I don't know whether I should be doing that now, given I still have enough estrogen knocking about to be menstruating, or whether I should wait.

There are two options usually. Your GP will always get a copy if they need to refer you.

If not...
The first is the fee includes a report from a consultant. A copy will usually be sent to your GP.

The 2nd is it's sent to you as a simple printed outcome with the stats on it (it's your info that you have paid for) and you can ask for your GP to have a copy.

TBH it's not hard to read your own results.
There is plenty of info online on what the figures mean and the results should show a graph with normal, osteopenia or osteoporosis.

That' s quite unusual not to have a DEXA scan any closer.
Have you looked at all your local private hospitals?

Your NHS will be providing them so ask your GP considering family history?

I’ve had two Dexa scans on the NHS. It’s very easy to read the results yourself and understand the meaning.

aslo get started on weights and impact exercise info haven’t already done so.

I’m also confused by it all. My only issue is dry eyes and fewer periods. I’ve joined the gym and am doing weights, my other ‘symptoms’ I think were just unfitness and being too heavy and they’ve disappeared.

Hi, I don’t know the answer to the questions about oestradiol dosage or scans, but I wanted to echo this poster and remind you that you (we all) must lift HEAVY weights throughout mid life and beyond to maintain bone density and muscle strength.

Dr Stacey Sims has some info on this. I read/heard her recently suggesting going as heavy as you can (and still maintain good form) for only 5-7 reps.

The older I get the more women I know who have become essentially disabled through osteopenia/sarcopenia. It’s not quite too late for them to improve, but it’s even harder once you’ve collected injuries than it is now.

Yes I'm aware of the weights and resistance training. I am doing my best with it but have other health stuff going on which makes it challenging which is part of the reason I want the extra 'layer' of benefit from HRT.

Thanks @JinglingSpringbells .

If you're going to use weights, it's a good idea to get a book or look at online videos of which areas to target.

Most fractures are hip fractures so you need to do the exercises for those- lunges and squats work, as do leg raises with ankle weights.

Although weights are good, there is some evidence that all the weights in the world won't replace lost estrogen and if you have element of prolapse, you need to be really careful with lifting heavy weights when standing.

The ‘lift heavy’ advice isn’t necessarily as heavy as you think, and needs less moves than you might realise.
Full info here from an OB/GYN menopause specialist with the results of studies showing what it actually takes to improve bone density in those with osteopenia, and how prevent bone loss in the first place.

https://vm.tiktok.com/ZNd7VGtY4/

This is a good place to start for weight bearing and impact exercise info.

https://theros.org.uk/information-and-support/bone-health/exercise-for-bones/

What are you calling 'heavy'? How many kilos per dumb bell?
She mentions 20lbs which is huge! (It's around a 9kg weight.)

There's no point doing some weights if you are not targeting the right muscles- mainly the hip and upper spine.

Also, she ought to be mentioning that jumps and dead lifts are a complete no-no for many women who have given birth. many have some element of prolapse (made worse after menopause) and those exercises make it worse.

I have osteopenia diagnosed through regular DEXA scans. It was significantly improved through increasing my vitamin D levels, so that may be worth testing. However, as I don't have any symptoms of perimenopause (I'm 47) neither my GP nor my endocrinologist will prescribe HRT to protect my bone density while I am still having regular periods.

That's quite odd @MotherofPufflings

Are you seeing an endocrinologist JUST for osteopenia? Or do you have other issues? Many women won't see one if they have osteopenia, so is yours quite severe? Is there another reason why you are having regular DEXA scans at 47?

HRT can't be given for prevention of osteoporosis without meno symptoms BUT it can be given for existing loss of bone density if you're heading towards osteoporosis. It depends on your T-score and how close it is to -2.5

Vit D doesn't increase bone density in itself, it just helps the uptake of calcium from diet.

I'm seeing an endocrinologist for the issues that have resulted in my osteopenia.

I appreciate that vitamin D doesn't have a direct effect, but it's really important for bone health and many people in this country are deficient, particularly in the winter. My level was on the low end of the normal range and I have been advised to aim for levels above 75 nmol/l because of my osteopenia.

So you have other diseases/ conditions that put you at risk of osteoporosis?
What is your T score at the moment?

I've been having DEXA scans privately for many years since I was diagnosed with pretty bad osteopenia, long before menopause.

On Vit D the NHS suggests everyone supplements at least from October to April and maybe on 1000mcgs a day.