400 IU to 800 IU per day could be considered as a preventive measure in those interested in bone health. Use of calcitriol for the treatment of either of these types of osteoporosis is not FDA approved and, thus, should be reserved for use by specialists. Annals of Internal Medicine. In addition, it may take 9 to 12 months of adjustments to develop the appropriate regimen for an individual patient and, unfortunately, many patients discontinue HRT before the appropriate adjustments are tried or can be made. Sometimes, doses of estrogen as high as 1.25 mg of conjugated estrogens or its equivalent may be needed to consistently protect against bone loss at the hip.
Higher doses are unlikely to benefit maintenance of bone mass.
If a patient does not tolerate one type of estrogen, consideration should be given to a trial of one or more different types. Close medical follow-up of patients taking estrogen is advised including mammography, pelvic examinations, PAP smears and, if needed, endometrial biopsies. There is no known additive role for progesterone compounds in maintaining bone mass. However, progesterone is necessary to prevent endometrial hyperplasia and should be given for this purpose. If the patient has no uterus, a progestogen is not indicated.