Why 1 In 4 Women On HRT Are Still Losing Bone (And How To Know If You’re One)

Dr. Doug Weiss gets down to the bones of it:

Personalization matters

When it comes to HRT and bone density, average improvements can be misleading because some women gain bone density while others continue to lose it, even when receiving the same estrogen dose.

However, it doesn’t all have to be guesswork: one study cited in the video found that women whose CTX levels fell by about 33% were approximately 87% likely to experience an increase in bone mineral density, suggesting that bone turnover markers can serve as early indicators of whether estrogen therapy is likely to improve bone health.

With this and other such results in mind, Dr. Weiss argues that CTX reflects bone breakdown, P1NP reflects bone formation, and measuring both provides a much faster way to assess whether a bone-health intervention is working than waiting 12–24 months or longer for changes on a DEXA scan; he uses a P1NP-to-CTX ratio target of approximately 150 as a marker of favorable bone metabolism.

While he doesn’t consider up-front testing to be especially important (because people can respond to treatments very differently, so while it’s an interesting baseline, an initial test result is not useable information yet), he advocates measuring estradiol, FSH, CTX, and P1NP after treatment begins and adjusting therapy based on individual results rather than relying on standardized dosing.

For more on all of this, enjoy:

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Take care!