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[Apple]

I'm just on holiday in Spain and attended the hospital for hip pain thinking a recent uti I was treated for hadn't cleared properly. I was x rayed and to my surprise I have osteoporosis in my left hip.

I'm 62 and only got a DR to agree to prescribe HRT to me at 55. At 60 the Dr lowered me to half the dose. I'm on Kliovance. One of my main reasons for wanting HRT was the prevention of Osteoporosis. I now feel like it's all been too little too late and it's failed. I really don't understand GP's.

I remember a friend of mine being on a geriatric ward years ago and a nurse saying to her half these women wouldn't be in here if they'd had HRT.

[bombsh3ll]

I'm sorry that has happened to you, sadly most women are on sub therapeutic doses that are not protecting them against osteoporosis.

What I would say is maybe double check the x-ray report - osteoporosis can be picked up on some x-rays particularly if severe, however it doesn't usually cause pain in the absence of a fracture, and they might just have been saying osteoarthritis.

The best test for osteoporosis is a DEXA scan, which you could ask you GP to refer you for when you get home.

I would also make sure you are on a bone protective dose of estrogen going forward (plasma estradiol at least 250-300pmol/L).

If it is osteoporosis you are blessed to have picked this up now rather than have a hip fracture 10 years later.

[CLKD]

Morning.  I would consider that your GP is negligent what were you told about cutting the dose?

MayB get a referral to a dedicated menopause Clinic and in the mean time take pain relief, lots of brisk walking and enjoy your holiday.

[laszla]

Just to say that I reversed my osteoporosis with hrt. Of the three T scores measured in a dexa scan, 2 indicated osteopenia and one osteoporosis. On a good dose of oestrogen, all three scores improved considerably, with the osteoporosis one now being only in the osteopenia range and the other 2 being close to normal. I had to achieve quite a high level of serum oestrogen to achieve this - about 650 and in my case that was only possible with implants as I didn't absorb gel or patches though of course some women will be fine on those.
Exercise is important too though in my case wasn't sufficient to improve me T scores sufficiently to get out of the osteoporosis range.

[joziel]

For osteoporosis prevention, the serum estradiol to aim for is 400pmol+ (according to Dr Newson in a recent podcast episode).

Sadly your experience is extremely common. Women take HRT and think it is a black and white thing - they are either 'taking' it or not. And if they are taking it, they assume they have all the benefits which come with it.

Really, the benefits of estrogen are dose dependent. If you are taking enough estrogen, you will probably have a bleed - because it will be causing your endometrial lining to thicken. If you're post-menopausal and not having a bleed and on continuous progesterone, then it's likely you are also not getting enough estrogen to protect bones, heart, brain etc. Doctors are very afraid of estrogen - still - and will typically be looking to reduce it, always.

It shouldn't be this way but women need to educate themselves, request blood tests, and ensure their estradiol is at a therapeutic dose - and advocate for increases if it isn't.

[Mary G]

My sister (in the UK) has finally opened up and started talking to me about the menopause and she told me she was diagnosed with osteopenia a year ago.  She was given a 50mcg patch and it has proved to be completely useless and her bone density is exactly the same one year on.  I've told her she needs to increase the HRT dose but the treatment she is getting is hopeless and she had to virtually beg her GP for the initial DEXA scan.  The follow up treatment is rubbish too and it's worrying that so many of her friends in her age group (late 50s) have osteopenia or full blown osteoporosis.

I'm 6 years older than my sister and have very good bone density but I've been on HRT for years. 

Even if as bomb says it's osteoarthritis, that is also caused by low oestrogen.  I would definitely have a DEXA scan.

[joziel]

It's so sad that the ball is in our court to basically educate ourselves and advocate for ourselves, in all this.

If men experienced menopause there would be a consultation they had at age 40 which would optimise everything and create a 'menopause plan' going forwards. The NHS can't even cope with current levels of demand, let alone what would be involved in doing all this properly.

[CLKD]

I do wonder if protocols are deliberately set so that women don't get proper treatment, i.e. with thyroid function testing ?  Within normal limits therefore? Even when patients continue to complain .......... 

[bombsh3ll]

That definitely happens when deciding on clinical guidelines for specific conditions.

State funded healthcare systems do take the cost into consideration of providing a particular treatment to X number of people. There is always a trade off between optimal clinical outcomes vs what is cheapest and how much the particular outcome is valued.

Whilst it is fairly easy to work out the cost of the treatment, savings down the road such as hip fractures and cardiovascular disease avoided by hormone therapy, plus all the additional medical appointments and investigations untreated women attend to get each menopausal symptom palliated separately, is far less easy to quantify, hence it is left out of the equation.

Unfortunately, the health and wellbeing of women who are seen to have outlived their societal usefulness as sex objects, baby factories and units of economic productivity, is not considered particularly important, and it doesn't necessarily go in the win column if we live to 85 instead of 80.

[Apple]

I've now been referred for a Dexa scan and waiting for that. I had a medication review today. I'm on Lanszoprazole for Gerd, Kliovance low dose hrt and Estriol cream. Lanszoprazole has been withdrawn because of the links with osteoporosis so I'm going to struggle with that. Surprisingly the GP wants to withdraw HRT altogether apart from the cream. She feels that if I can handle symptoms there's no benefit after 60 and more risks. She's left it in place for now but we are going to review again after the Dexa scan results. I had actually approached her thinking that increasing the dose from Kliovance to Kliofem might be beneficial. Her thinking is completely the other way.

If the Dexa scan confirms osteoporosis her approach is Biophosphonates. After a little research I found these trigger reflux and I will no longer be on Lanszoprazole 😩. The alternatives are injectables but the cost is high so I know the NHS will opt for the tablets. So I may be looking at a future off HRT and on Biophosphonates which trigger reflux that I am no longer on the Lanszoprazole for. Sounds lie a great plan 😩

[CLKD]

Your GP is ignorant.  There is no need for any of us to stop HRT if required.  She's not keeping up with current protocol!  MayB it's down to Practice costs?

If something works, continue using it.  If the GP isn't keen to continue ask for a referral to a dedicated menopause clinic.

I'm taking omeprazolol each morning with no idea that these drugs cause osteoporosis - what happened to quality of life?  . U don't have to struggle with this!

[joziel]

Apple, I think you need a new GP. Your future health depends on it and you should act with your feet. It is well known that estrogen is a fantastic way to address osteoporosis without the risks which biophosphonates cause. A quick google or ChatGPT will tell you that.

Please change GP practices and find a practice with a doctor who is better educated in menopause care. You don't have to stay with this GP and this poor level of medical treatment.

[Ayesha]

When I first read your update I immediately thought what bad advice from your GP.
I am not on systemic HRT but If I was diagnosed with osteoporosis I would refuse to take biophosphonates, the side effects seem horrendous and I certainly would not stop my omeprazole. As I am not on HRT apart from topical, I would be seeking out the supplement route, same as a relative who is doing very well with her osteoporosis diagnoses and refusing to take bisphosphonates and won't consider systemic HRT.

You really should seek a second opinion.

[bombsh3ll]

That is harmful and negligent - where is your autonomy and the shared decision making that is supposed to underpin good medical care.

Untreated acid reflux is incredibly uncomfortable and harmful, and would only be made worse by bisphosphonates.

Fortunately in the worst case scenario you can buy PPIs over the counter until you can see someone else and get your prescription reinstated, in addition to a therapeutic dose of estrogen.

Please insist on seeing a menopause specialist for appropriate treatment - estrogen is much more effective plus safer and improves quality of life and numerous other health outcomes vs bisphosphonates.