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[pineneedles]

Hello Forum,

So, it turns out the DEXA scan I was referred to was very much needed, because it showed osteopenia in the lowest femoral neck as well as borderline in the hips:

Sorry the formatting is a little skeewiff:

Body Part Area BMD (g/cm2) T-scores Z-scores
Lumbar Spine         L1-L4         1.135      -0.5      -0.5
Lowest Femoral Neck            Left         0.801      -1.5      -1.3
Hips  Mean L&R Total  Femur          0.876      -1.0       -0.9

As a silver lining I am glad the lumbar spine score is OK... so far 

It was a bit of a blow, though, because I am only 43 (diagnosed in early menopause earlier this year but may have been earlier since I actually had symptoms for a few years before), already exercise, eat healthily including green veg, dairy, tofu and sardines with bones, take a vit-D supplement. On HRT since this time last year (first Evorel 50, then 75 since the summer). I grew up drinking milk daily and had an early puberty as well, which apparently is potentially helpful in building bone mass in adolescence, but of course I don't know what my baseline really was. Doesn't matter now.

I have my appointment at the menopause clinic again in the new year but want to make sure I start doing everything I can to protect my bones straight away. I had a wrist injury last year which I thought was just a ligament but may also have been a stress fracture since the bone is still painful from time to time, and have had hip joint injuries from running in the last five years as well. Plus osteoarthritis in the fingers and toes and advice from podiatrist to avoid putting pressure on the big toe joints. So I need to be careful with the amount and type of exercise I do.

This is my action plan. Is there anything else I can/should do now?
- Monitor diet to ensure I get to 1200mg calcium daily (including 400mg from menopause supplement)
- Vit D3 + K2 spray 3000iu daily (previous version was just Vit D 1000iu)
- Seeing a personal trainer specialising in menopause who can help me build an exercise programme to maintain (or even repair?!) bone density
- Have another estradiol blood test before clinic appointment and get higher HRT dosage until can get level increased to 300pMol/l (last result in July 124 pMol/l)

The recommendation was to get follow-up scans every 3-5 years but that seems like a long time to wait. Has anyone had these done privately in between and what was the cost of that?

I was feeling kind of OK about the early menopause thing, with an improvement to most of my menopause symptoms, although still also have an ongoing cardiology investigation into buzzing/palpitations which are suspected to do with bradycardia that came up on the 24-hr ECG. But the prospect of being in osteoporosis in my 40s makes me want to weep... And feels like the battle against this is going to be a full time job!

Would love to hear others' experiences and advice on this.

[Cassie]

Theres lots of support on FB on the Osteoporosis Education & Support group. It sounds like you are doing the right things, I also have it but went through early meno and have also recently tried to up my Estrogen levels so that I can get a better reading as there is a min level of E required, in order to offer bone protection.
Weight bearing exercises very good, I do Pilates and walk a lot carrying a weighted bag on my back. The PT I saw said one should aim to lift approx 15% of your body weight. I think its important not to let this get to you mentally, my mom lived to well in her 90s and am sure she had osteoporosis as she was small framed but she never fractured and was relatively healthy right through. Have heard lots of nasty side effects from most of the drugs so trying to do it the HRT way with supplements & exercise for now.

[pineneedles]

Thank you, Cassie! Will check out that FB group. I also already do Pilates. Was doing circuit training type strength classes too, but had to pause that because of the wrist injury and haven't gone back because there are now so many common exercises I need to continue to avoid because of either the wrist or my toes (push-ups, burpees, lunges etc). Hoping the PT will tell me which moves to focus on and motivate me to do the exercise at home. I do have kettlebells at home, and the heavier ones are 15% of my body weight.

And yes, I'm trying to stay positive about this but it's also the cumulative impact of doctor appointments and tests and diagnoses in the last 12 months and this one just made me feel like I'm on a fast track to hip fractures and becoming bed-bound before I even get to retirement age. I know I am prone to catastrophising so will try to keep a steady head on this...

[pineneedles]

Thank you jaypo! Yes, I had heard that about calcium supplements but thought the risk was at higher doses. I do have possible heart disease risk as well because of family history, so it is definitely something to keep in mind.

In the summer I am very happy to get my vit D dosage from the sun 

[Mary G]

pineneedles, you need more oestrogen, it's as simple as that. HRT is the first line treatment for osteopenia and osteoporosis and nothing else is going to cut through and make a significant difference.  There is medication you can take but it has horrible side effects.  HRT actually reverses osteopenia. 

Your oestrogen blood level is far too low and you are obviously not absorbing the patches well.  I would either increase the patch dose or switch to Oestrogel which is stronger and usually has better absorption rates.

You probably need testosterone replacement too.

[pineneedles]

Thank you for making it as clear as that, Mary G!

I will see if I can get the GP to refer me for the hormone level blood tests now rather than waiting for the clinic appointment. Then at least I know where I am at and whether the higher patch has made any difference.

[Aprilflower]

pineneedles, you need more oestrogen, it's as simple as that. HRT is the first line treatment for osteopenia and osteoporosis and nothing else is going to cut through and make a significant difference.  There is medication you can take but it has horrible side effects.  HRT actually reverses osteopenia. 

Your oestrogen blood level is far too low and you are obviously not absorbing the patches well.  I would either increase the patch dose or switch to Oestrogel which is stronger and usually has better absorption rates.

You probably need testosterone replacement too.

This is not an option for those who have had oestrogen positive breast cancer or DCIS.

I was advised to take calcium and vitamin D but these can create problems if too high a dose is taken.

It's important to remember that 50% of women are believed to have osteopenia from the age of fifty.  It is not a given that it will progress, or you will have a fracture.

[Mary G]

pineneedles, you need more oestrogen, it's as simple as that. HRT is the first line treatment for osteopenia and osteoporosis and nothing else is going to cut through and make a significant difference.  There is medication you can take but it has horrible side effects.  HRT actually reverses osteopenia. 

Your oestrogen blood level is far too low and you are obviously not absorbing the patches well.  I would either increase the patch dose or switch to Oestrogel which is stronger and usually has better absorption rates.

You probably need testosterone replacement too.

This is not an option for those who have had oestrogen positive breast cancer or DCIS.

I was advised to take calcium and vitamin D but these can create problems if too high a dose is taken.

It's important to remember that 50% of women are believed to have osteopenia from the age of fifty.  It is not a given that it will progress, or you will have a fracture.

As far as I'm aware pineneedles doesn't have a history of breast cancer.  She is only 43 and I'm sure she could benefit from HRT and prevent any further bone lose or even reverse it so why take the risk?

My sister is 58,  has osteopenia and has never used HRT until recently. I'm 64, I've been using HRT for about 18 years and have excellent bone density.  I'm convinced it makes a big difference.

The NHS recommends HRT for osteopenia.

[Aprilflower]

I had a late meno, 57, so was surprised to have it.  Nevertheless one in seven women will have BC so it has to be taken into account.  Was not something I thought about until it happened to me.

[sheila99]

I echo what Maryg says about oestrogen. You need a level of at least 250, preferably 300. You can get tested your self if the NHS won't (Randox, medichecks etc) but if you're peri make sure you do it when your own hormone production is at it's lowest at the start of your period.

[AmandaJR]

Hi Pineneedles, your experience is very similar to mine, I know it’s really frightening initially.
I was diagnosed with osteopenia by DEXA a year ago at age 40. Two weeks prior I got the osteoarthritis in hip ticket too. November 2024 was a real blow but I’m glad I found out.
My GP ran hormone tests and I’d stopped absorbing oestradiol, level was 80pmol. It’s not allowed to be under 400 pmol now, the GP texts me to adjust dosage if the level dips below 400pmol but I feel better with higher levels, it’s very individual.

I also do a cheap hormone panel test every few months to monitor E,P & T.

Your action plan is the same as mine, I’ve stopped prescription calcium and eat calcium rich foods instead. I was told to wait 3 years for the next DEXA, I’m doing it next week and hope to see improvements.

I was told by the DEXA scanner and two orthopaedic surgeons that the cause of both my conditions was sex hormone deficiency so am hoping my next DEXA confirms this.

I’m a runner too, 5 months off due to hip pain but now back on track!

I know it’s a shock but keep going with your action plan.

Mandy.

Edit to add link, this info from Dr Louise Newson is good especially with the references at the bottom:

https://www.drlouisenewson.co.uk/knowledge/how-can-i-keep-my-bones-strong

[laszla]

HRT reversed my osteoporosis (in neck of femur) and significantly reduced my osteopenia in hip and spine. Once I was on a formula that ensured good absorption of quite high levels of serum estradiol (implant in my case and about 600-700 pmol) the improvement was quite quick.

It's the most concrete and easily measurable example of how good levels of E2 can improve things.

[AmandaJR]

HRT reversed my osteoporosis (in neck of femur) and significantly reduced my osteopenia in hip and spine. Once I was on a formula that ensured good absorption of quite high levels of serum estradiol (implant in my case and about 600-700 pmol) the improvement was quite quick.

It's the most concrete and easily measurable example of how good levels of E2 can improve things.

This is so good to read, thank you so much for posting this Lazla. I’m so pleased for you.  I keep my levels around 850 pmol and am hoping for improvement in bone mass density. I certainly feel huge improvement with osteoarthritis.

[pineneedles]

Thanks, everyone. Thankfully there is no reason I cannot have (more) HRT, so I have hope that higher dose or a different method will help there. Even the dose I am at has alleviated most other menopause symptoms, so I must have been very low before? But will request blood tests now.

I do feel a bit sceptical of the notion that it is normal for women over 50 to have osteopenia, since it may have been that when these stats were produced it was a generation of women who weren't offered HRT even if there was no other health reason they could not have had it? Or am I missing something? In any case, as being in early menopause, osteoporosis is an increased risk for me and my priority to manage by HRT at the moment.

My grandmother shrunk a lot in her 60s and upwards and did become fragile and broke a hip and died in her late 80s (of non-breast cancer). My mother is now 78 and has lost some height as well but hasn't broken any bones, although she has lost her mobility for other reasons including arthritis. (I can't really talk to her about health issues as she makes my health anxiety worse, so I don't know if she has ever had a bone scan, but I'm pretty sure she had her menopause at a normal age in her 50s and never had HRT.)

Mandy, thank you for sharing your experience. Please let me know how your follow-up scan goes!

Laszla, this is so reassuring to hear. Very happy you are getting such good results!

[Aprilflower]

https://theros.org.uk/information-and-support/osteopenia/

This is the best source of information I know.