
So, I mentioned in yesterday’s post that I would write about my new plan of action. It’s fairly specific to me, because at 54-years of age, my lumbar spine has been diagnosed with a t-score of -3.3, which is already half way through the osteoporosis scale heading for really severe (-4.0), whereas my hips are only osteopenic, (-2.1), but inching fairly close to osteoporosis themselves. This difference is common in connective-tissue–related bone fragility. So, maybe none of this would really apply to a fifty-something-year old woman who did NOT have hEDS. And even then, not everyone with hEDS will get dealt this osteoporosis card, (or the heart mitral valve card either, for that matter).
I used Chat GTP as a sounding board for the things I am about to talk about in this blog. To be clear, Chat GTP did not diagnose me. I was diagnosed by a doctor, by an echocardiogram done at a hospital, by a bone density scan done at a radiology clinic, and even by a Dexa scan, which even though is not considered medically diagnostic according to my doctor, did show questionable findings that got the ball rolling for me. (Best $249 I ever spent on that Dexa! The rest is covered by my medical insurance).
Anyhow, Chat GTP has real information at its disposal on my real diagnosed medical conditions, so it was a great place to have an evidence-based and knowledgeable chit chat. This is not medical advice, it’s just my experience and decisions based on information I have gathered.
When it comes to the different t-scores between my spine and my in my hips, the bone densitometry I had done on October 3, 2025, also looked at the neck of the hip versus the total hip, where again there was a slight difference for me:
“In your case:
• The total hip is lower than the neck
• This suggests relatively greater compromise of cortical bone than trabecular bone at the hip
This pattern is actually very consistent with connective-tissue–related bone fragility, where:
• Collagen defects affect bone matrix quality
• Cortical bone can become thinner and less resilient
• BMD may underestimate true fracture risk.”
Hmmm. Good to know.
Here’s the interesting part, if my osteoporosis was just because I started menopause about 2.5 years ago, then firstly, my t-score should not be this bad already! It’s only been 2.5 years! So we can feel confident my osteoporosis is connective-tissue related. And:
“Contrast this with:
• Postmenopausal estrogen deficiency, which often hits trabecular bone first (neck worse than total).”
Okay. It is my total hip that is worse, not the neck, (and it’s my spine that is really bad for my age). None of this would make any sense, really… except in terms of my having hEDS.
Because I have hEDS, I am very hesitant to take any bisphosphonates (like Fosomax) because of my digestion issues related to having hEDS. “GI intolerance risk is meaningfully higher in your case.”
And besides, for me specifically:
“Potential limitations of Fosamax for you
• It does not address collagen or bone quality
• It can over-suppress remodeling, which:
• May be problematic when baseline bone quality is abnormal
• Is a concern raised specifically in some hEDS populations
• Spine BMD gains tend to plateau quickly
• Fracture risk reduction in younger postmenopausal women with non-classic osteoporosis is less robust than in older populations.”
Yeah. Many women with these same t-scores that I have, are actually much older than me. I have strong legs and good balance, (and I can work on increasing my core strength also), so I am not really at risk of falling in the same way a woman coming up on 80-years old would be, (although if I did fall, I could break more easily, yes, that is true). Fracture risk is a huge concern for older women, especially in their seventies and eighties. All it takes is that one fall, leading to a fracture, and they can lose their independence. Woman in their seventies and eighties that find themselves with significant osteoporosis need to pull out the big guns to get the best return on their fall prevention investment.
I need to invest in fall prevention too, but, in theory, I should have many decades of life ahead of me, so it would probably not be good to be taking harsh medication for the next 30+ years!?!
Anyhow, even though my bone loss is not directly caused by menopause, that certainly has not helped things.
“But here’s the key distinction in your case
Postmenopausal osteoporosis:
• Primary problem = estrogen deficiency
• Estrogen replacement can be foundational therapy
Connective-tissue–related osteoporosis (suspected hEDS pattern):
• Primary problem = bone matrix / collagen quality
• Estrogen deficiency is secondary or additive
• Estrogen cannot correct defective bone scaffolding
So in your situation:
• Estrogen may help reduce the speed of loss
• It may slightly improve spine BMD
• But it cannot reverse the underlying fragility
This is why your hips are osteopenic, not osteoporotic — estrogen deficiency alone does not explain your pattern.”
So, estrogen may help a bit, so that is what my doctor and I have decided to do, good old Hormone Replacement Therapy (HRT). Sure, there is a slight increased risk of breast cancer, but leaving my osteoporosis unchecked has risks also. Everyone must make their own informed decision in this regard, weighing benefits versus risks. (And for me personally, I am also taking micronized progesterone, because I still have my uterus, so a balance of both hormones on HRT is protective for that).
And for people with osteoporosis primarily because of menopause, if their doctor recommends it, I thought this was interesting:
“For lumbar spine osteoporosis, the timing of estrogen therapy is critical, with the greatest benefits occurring when treatment is initiated in the “window of opportunity” which is in the early postmenopausal years (typically within 10 years of menopause onset or before age 60).
Key Timing Effects
- Early Initiation (Critical Window): Starting estrogen soon after menopause is most effective for preventing rapid bone loss. The first 5 to 7 years after menopause are when the most significant bone loss occurs in women due to estrogen deficiency. Initiating therapy during this period helps stabilize bone mineral density (BMD) in the lumbar spine and effectively reduces the risk of future fractures.”
I am only be 2.5 years into menopause. So, I now begin HRT as part of how I am starting to work on this problem for myself, based on my own personal “issues with my tissues,” that have been most probably been the main cause for me of this significant osteoporosis problem in the first place. And it looks like I am still within this good window of opportunity to be starting HRT.
That is it in a nutshell. I hope everyone has a wonderful New Year’s. Even with health concerns, being in the driver’s seat of my decisions, and putting those decisions into action, certainly feels better than instead simply allowing myself to be influenced, without taking the time to gather an adequate amount of empowering information on which I can make my own decisions.











