Best Online HRT for Osteoporosis: What Actually Works, and Who It’s For
If you searched best online HRT for osteoporosis, you’ve probably already heard that estrogen helps your bones. That part is true. But there’s a catch almost every “best HRT” list skips, and it changes who should buy what.
Here’s the bottom line, up front. For the right woman, FDA-approved hormone therapy— hormones tested and approved by the U.S. government — can help prevent bone loss and lower fracture risk. Our pick for the best online starting point is Midi Health: it prescribes FDA-approved estradiol (the main estrogen used in HRT), it’s in-network with most major PPO plans, and its clinicians can order labs or imaging like a bone scan. Midi says most insured patients pay about $50 a visit; if you pay cash, it’s $250 for the first visit and $150 after that (Midi Health, Pricing & Insurance, 2026). For a cash-pay option, Sesame is the strongest pick.
Now the catch. HRT is not FDA-approved to treatosteoporosis you’ve already been diagnosed with. If a bone scan already says you have osteoporosis — or you’ve broken a bone from a small fall — online HRT by itself is not your starting point. That situation usually needs a clinician and a different kind of bone medicine first.
Best for / Not for You If
This page is for you if…
You’re in or near menopause, you’re worried about your bones (low bone density, “osteopenia,” a scary scan, or family history), and you want to know whether you can get hormones online to protect them — and from whom.
This page is not for you if…
You’re looking for an online company to replace urgent care after a broken bone, or to fully manage a serious osteoporosis diagnosis. We’ll point you to the right kind of help instead.
The HRT Indexis the independent decision resource for online menopause and HRT care — comparing telehealth providers on clinical legitimacy, care quality, medication fit, price transparency, and access, with every claim verified and dated, so women can choose the path that fits their situation before their first consult.
Three Quick Paths — Which One Sounds Like You?
Before any provider talk, find yourself here. This one table is the whole decision in miniature.
| Your situation | Your best starting path |
|---|---|
| Menopause symptoms and/or a bone-loss worry, no broken bone, nottold you’re high-risk | Online menopause-HRT visit may be a reasonable start |
| Diagnosed osteoporosis, an abnormal bone scan, or you’re already on a bone medicine | Online menopause care plus a bone-focused clinician, together |
| A recent “fragility fracture” (a broken bone from a minor fall) or you’ve been told you’re very high-risk | An in-person or bone specialist first |
This is starting-point routing — not a diagnosis, not medical clearance, and not a recommendation for any specific drug.
The right online HRT provider isn’t the same for every woman— it depends on your symptoms, your age and whether you have a uterus, your medication route preference (patch, pill, gel, or vaginal estrogen), your risk history, your insurance or cash-pay situation, and your state. Use The HRT Index’s Find My HRT Path toolto match your situation to the right provider — and to flag when online care isn’t the right starting point — before your first consult.
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The HRT Index may earn a commission if you start care through some links here. It never changes your price or our picks — fit and current evidence decide placement, not payout. Affiliate disclosure
Can You Treat Osteoporosis with HRT — or Only Prevent Bone Loss?
FDA-approved estrogen can help prevent postmenopausal bone loss and lower fracture risk, but it is not FDA-approved to treat osteoporosis you already have.The Menopause Society confirms that hormone therapy prevents bone loss and reduces fractures in healthy postmenopausal women (The Menopause Society, 2022). If you’ve already been diagnosed with osteoporosis, the usual first treatment is a bone-specific medicine, managed by a clinician.
This one fact is why “best HRT for osteoporosis” is almost a trick question. There are really two different shoppers typing it:
- The woman trying to protect bones that are still mostly okay (prevention). HRT can fit here.
- The woman trying to rebuild bones that are already weak (treatment). HRT alone usually doesn’t fit here.
| Your question | The verified answer | Source |
|---|---|---|
| Does HRT prevent bone loss? | Yes. Estrogen slows the bone breakdown that speeds up after menopause, with bigger effects at higher doses. | The Menopause Society, 2022 |
| Does HRT lower fracture risk? | Yes,in healthy postmenopausal women. The FDA’s 2026 update points to fewer fractures (and lower death rates) when HRT starts within 10 years of menopause or before age 60. | The Menopause Society, 2022; FDA, 2026 |
| Is HRT approved to treat existing osteoporosis? | No. It’s approved to prevent bone loss, not to treat a diagnosis. | The Menopause Society, 2022; FDA labels |
| When does the FDA say estrogen-for-bone makes sense? | For women at significant riskof osteoporosis, and when non-estrogen bone medicines aren’t a good fit. | FDA estrogen labels (e.g., Premarin), 2025 |
| Does vaginal estrogen protect bone? | Low-dose vaginal estrogen treats dryness and urinary symptoms, not whole-body bone loss. (One ring, Femring, is the systemic exception — more below.) | The Menopause Society, 2022 |
| Is “compounded” or “bioidentical” estrogen better for bones? | No.Compounded products aren’t FDA-approved and carry no bone approval, and the FDA has no evidence they’re safer or work better. | FDA, Menopause consumer page |
The encouraging part — and it’s new
In 2026, the FDA approved labeling changes for an initial set of six menopausal hormone therapy products. It removed the old “black box” warnings about heart disease, breast cancer, and dementia from those products, and pointed to real benefits — including fewer fractures— when therapy starts in the right window (FDA, 2026). The agency also kept a boxed warning about uterine-lining cancer for systemic estrogen-alone products, and serious risks like blood clots and stroke still need a personal check. But the fear-first era is fading — and bone protection is one reason why.
Which FDA-Approved Hormones Are Actually Approved to Help Prevent Osteoporosis?
Not every estrogen product carries a bone approval — but several do. FDA-approved options specifically labeled to help prevent postmenopausal osteoporosis include conjugated estrogens (Premarin), oral estradiol (Estrace), certain estradiol patches (Menostar, Vivelle-Dot, Climara), and the estrogen/SERM combination Duavee.This is the part competitors leave vague, so here’s the specific list.
| FDA-approved product | Type | Bone note |
|---|---|---|
| Premarin (conjugated estrogens) | Oral pill | Labeled for menopause symptoms and prevention of postmenopausal osteoporosis |
| Estrace (estradiol) | Oral pill | Estradiol pill; estrogen therapy is FDA-approved for osteoporosis prevention |
| Menostar (estradiol) | Skin patch | A low-dose patch approved specifically to help prevent postmenopausal osteoporosis |
| Vivelle-Dot, Climara (estradiol) | Skin patch | Patches labeled for menopause symptoms and osteoporosis prevention |
| Duavee (conjugated estrogens + bazedoxifene) | Oral pill | For women with a uterus — protects the uterine lining without a separate progesterone, and is approved for osteoporosis prevention |
Sources: FDA product labeling; Cleveland Clinic Journal of Medicine; clinical trial records, verified 2026.
When you talk to an online clinician, you can say: “If I’m a candidate, I’d like an FDA-approved systemic option that’s labeled to help protect bone.” That one sentence keeps you in the approved, bone-relevant lane.
One supply note for 2026:estradiol patches are in short supply (ASHP; NPR, 2026). If you prefer a patch and your prescriber can’t get it, ask about gel or spray — both deliver systemic estradiol through the skin and have similar bone data to patches.
Is Online HRT the Right Starting Point — or Do You Need a Bone Specialist First?
Online menopause care can be a reasonable start when your goal is prevention or symptom relief and you have no broken bone or high-risk diagnosis. A diagnosed case, an abnormal scan, or a recent fracture should bring in bone-focused care — online HRT alone isn’t enough.
Path 1 — Online menopause visit may be a reasonable start
This fits you if you have menopause symptoms (hot flashes, night sweats, sleep trouble) and/or a worry about bone loss, but you haven’t been diagnosed with osteoporosis and you’ve never had a fragility fracture. An online clinician can review your symptoms and history, decide whether you’re a candidate for systemic HRT, and flag if you need a bone scan.
A quick word on bone scans. A DEXA (a fast, painless X-ray that measures bone density) gives you a T-score— a number that helps sort your bones into normal, thinning (osteopenia), or osteoporosis range. For screening, the U.S. Preventive Services Task Force recommends a DEXA for all women 65 and older. For younger postmenopausal women, it recommends first checking your risk factors and screening when your estimated fracture risk is high (USPSTF). That screening advice is for women who don’talready have osteoporosis — if you’ve been diagnosed or had a fragility fracture, you’re past screening and into management.
Path 2 — Online menopause care plus a bone-focused clinician, together
This fits you if a scan already says osteoporosis, your DEXA is abnormal, you’re already on a bone medicine, or there are open questions about why your bones are thinning. HRT may still be part of your plan. But established osteoporosis often needs its own evaluation and treatment, so the smart move is to run both tracks at once rather than hoping one HRT visit covers everything.
Path 3 — In-person or bone specialist first
This fits you if you’ve recently had a fragility fracture, you have multiple or serious spine fractures, or you’ve been told your fracture risk is very high. The Endocrine Society recommends prompt medicine for postmenopausal women at high fracture risk — especially soon after a fracture — and bisphosphonates (the most common bone-protecting drugs) are often the starting treatment (Endocrine Society). Telehealth menopause care can join the plan later, but it shouldn’t delay fracture-focused care.
The honest truth across all three: noneof the online providers we reviewed publicly documents a full, standardized osteoporosis program — meaning DEXA review, fracture-risk scoring, bone-specific medicine, and specialist referral, all in one place. That’s not a scandal. It just means “online HRT” is a great door for prevention and a poor door for treating a diagnosis. Knowing which door you need is the whole game.
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What Is the Best Online HRT for Osteoporosis in 2026?
For an appropriate prevention candidate, Midi Health is the strongest insurance-oriented online starting point, and Sesame is the strongest cash-pay option. Both prescribe FDA-approved hormones. Neither replaces bone-specific care after a fracture or for high-risk osteoporosis.
This is our Bone-Fit Provider Matrix— the part you’d otherwise have to build yourself by opening a dozen tabs. We compare the things that actually decide a boneoutcome: the medication category, whether the route reaches your whole body, insurance, scan support, price, and states. We don’t score providers with made-up numbers. We show what we verified and what you must confirm at checkout.
| Provider | Medication category | Reaches whole body? | Insurance / cash | DEXA support | Price (confirm at checkout) | Best for |
|---|---|---|---|---|---|---|
| Midi Health Top pick | FDA-approved estradiol (patch, pill, vaginal) + progesterone | Yes — systemic patch/pill | In-network with most PPO plans; no Medicare or Medicaid | Clinicians can order labs or imaging; no standardized scan-and-refer program publicly documented | ~$50/visit insured; $250 first / $150 follow-up cash | Insured women who want FDA-approved systemic HRT with bone-aware care |
| Sesame Best cash-pay | Lists FDA-approved hormones; clinicians may also offer compounded — confirm which you get | Yes when FDA-approved estradiol prescribed | Cash (HSA/FSA); not billed to insurance | Lists alendronate, risedronate; basic labs if ordered | ~$99/month (2025 review) — confirm current price + what’s included | Cash-pay women who want a real clinician to evaluate them |
| Hers | FDA-approved estradiol options | Yes when FDA-approved estradiol prescribed | Cash subscription | No public scan/bone-medicine pathway found | Oral ~$79/mo, patch ~$134/mo (12-month plan) | Women who want a simple, direct-to-door FDA-approved estradiol plan |
| Winona | Markets estradiol patch + tablets as FDA-approved and compounded creams — but its Help Center says Winona’s treatments are not FDA-approved (dispensed via 503A compounding pharmacies) | Patch/tablet if truly FDA-approved: yes; compounded creams: confirm | Cash (HSA/FSA); no insurance billing | No public scan/bone-medicine pathway found | Patch $149, tablets $54, progesterone $39, cream $89/mo | Cash-pay women who want a patch — only after confirming FDA status |
Commercial figures checked June 25, 2026 on each provider’s own pages. Prices and policies can change — confirm at checkout. “States” means the states where a provider accepts patients; confirm yours before booking.
Midi Health — our top pick for insured women
Midi bills most major PPO plans (Aetna, Cigna, Anthem BCBS, UnitedHealthcare) and prescribes FDA-approved estradiol — the same estrogen your body makes, and the kind that carries bone approvals. Midi clinicians can order labs or imaging when needed, and a patient has reported a Midi clinician ordered a DEXA scan for her. A standardized bone-scan-and-refer program is not publicly documented, but the clinical breadth is there. Midi serves all 50 states and does not cover Medicare or Medicaid.
Best for: insured women in PPO plans who want FDA-approved systemic HRT with a clinician who can flag bone issues and order labs.
Price: ~$50/visit insured (Midi’s stated average); $250 first visit / $150 follow-up cash-pay — confirm at checkout. Labs and medication billed separately.
Affiliate link: we may earn a commission if you use this link.
Sesame — best cash-pay option with bone-medicine access
Sesame stands apart from the other cash-pay options because its clinicians can list common bone medicines like alendronate and risedronate — not just hormones. That’s meaningful for Path 2 women who want both tracks evaluated in one place. Clinicians are independently licensed; pick one whose state license covers yours, and confirm the exact medications available before booking.
Sesame also lists FDA-approved hormones — confirm your clinician is prescribing the FDA-approved version, not a compounded one, if bone approval matters to you.
Price:a 2025 review listed ~$99/month — confirm current price and what’s included at checkout. Medication billed separately through your pharmacy.
Affiliate link: we may earn a commission if you use this link.
Hers — simple and direct for cash-pay FDA-approved estradiol
Hers prescribes FDA-approved estradiol (oral and patch options) and ships to most states (not NC or AR). There is no public bone-medicine pathway or DEXA program, so Hers fits Path 1 women who primarily want symptom relief and bone-loss prevention, not anyone who needs a scan or bone medicine managed online.
Price:oral ~$79/month, patch ~$134/month on a 12-month plan (2026 listings) — confirm at checkout.
Affiliate link: we may earn a commission if you use this link.
Winona — confirm FDA status before you book
Winona markets an estradiol patch and tablets as FDA-approved while also offering compounded creams. But Winona’s own Help Center states that Winona’s treatments are not FDA-approved — dispensed via 503A compounding pharmacies. That’s a conflict within Winona’s own materials, which we label Conflicting per our verification standard.
If you choose Winona, ask directly: is the specific product you’re being prescribed an FDA-approved finished drug or a 503A compounded preparation? Only FDA-approved products carry a bone approval. Compounded versions do not.
Price:patch $149, tablets $54, progesterone $39, cream $89/month — confirm at checkout.
Affiliate link: we may earn a commission if you use this link.
What Does Online HRT Actually Cost for Bone Protection?
The cheapest ongoing option is Midi if you have a PPO. Cash-pay options vary widely once you add labs, medication, and a potential bone scan to the advertised monthly number.
- Insured through a PPO? Midi is usually the lowest total cost. Midi bills most PPO plans, and its stated average is about $50 a visit; FDA-approved generic estradiol is often inexpensive on your pharmacy benefit. Two visits a year plus a low-cost generic can keep your annual cost modest.
- Paying cash and want a clinician to evaluate you?Sesame’s subscription (a 2025 review listed ~$99/month — confirm at checkout) can include visits and basic labs, with medicine sent to your pharmacy. Sesame also lists bone medicines, which the others don’t.
- Paying cash and want it simple?Hers (oral ~$79/month, patch ~$134/month on a 12-month plan — confirm) ships to your door.
- Paying cash for a specific product?Winona prices by product ($39–$149/month) — but confirm the FDA status first.
- Add a bone scan if you need one.A DEXA is often covered when screening is recommended (women 65+, or younger women with risk factors). Online HRT platforms generally don’t include imaging, so a scan is usually billed separately through your insurance or an imaging center.
The headline: if you have a PPO, Midi is usually the lowest total cost for ongoing bone-protective HRT, because coverage keeps the running cost near a copay. If you’re paying cash, compare the wholeplan — not just the advertised monthly number — because medicine, labs, and a scan can change the math fast. For a full breakdown, see our HRT cost and insurance guide.
Does Insurance Cover Online HRT and a Bone Scan?
Coverage depends on the provider, your plan, the test, the medicine, and your diagnosis. Midi is the strongest insurance option here; Sesame, Hers, and Winona run mainly on cash or HSA/FSA. FDA-approved generic hormones are widely covered; compounded products usually aren’t.
- PPO plans: Midi is in-network with most major PPO plans (Aetna, Cigna, Anthem BCBS, UnitedHealthcare). Coverage varies, and deductibles, copays, and coinsurance still apply.
- Medicare and Medicaid: Midi is notcovered by Medicare or any Medicare-related plan — Medicare members can pay cash but can’t bill Midi to Medicare. Midi also cannot treat Medicaid or Medi-Cal patients at all, even as self-pay (Midi Health, 2026). If you have Medicare or Medicaid, a local clinician or in-person practice is usually the better route.
- Medicine:FDA-approved generic estradiol and progesterone are widely covered. Compounded hormones (Winona’s creams) are typically not covered, and the FDA recommends using FDA-approved hormones (FDA).
- DEXA scans:Commonly covered when screening is recommended — for example, women 65 and older, or younger postmenopausal women at higher fracture risk. Confirm with your plan.
For the deeper how-to — appeals, prior authorization, and getting a denied scan covered — see our HRT insurance guide.
How we verified this (The HRT Index Verification Standard) — Last updated
The HRT Index Verification Standardis our documented process: we read every published price, separate FDA-approved from compounded, verify state availability and insurance, and re-check on a fixed schedule — top providers monthly, the full roster quarterly. We evaluate providers on exactly five things, in this order: clinical legitimacy, care quality, medication fit, price transparency, and access. We never turn that into a numeric score, and we never invent reviews or ratings.
Our evidence labels:
- Verified — stated on a current provider page or an authoritative source.
- Provider-stated — the company says it, but it’s a claim, not independent proof.
- Conflicting — a provider’s own materials disagree (as Winona’s do on FDA status).
- Not publicly documented — we couldn’t find it on public pages.
- Confirm at checkout — a number or detail that can change; verify before you pay.
What we actually verified on June 25, 2026:
- Each provider’s published pricing, medication list (FDA-approved vs. compounded), insurance model, state availability, and policies — from each provider’s own pages.
- Medical and regulatory statements checked against the FDA, The Menopause Society’s 2022 Hormone Therapy Position Statement, the Endocrine Society, the USPSTF, and the ASHP drug-shortage bulletin.
- FDA labeling changes (2026) removing black-box warnings from six menopause HT products — verified against the FDA press release and updated labeling.
- Winona’s FDA-status conflict — cross-referenced against Winona’s public marketing pages and its own Help Center.
We did not pose as patients, complete paid consultations, or claim firsthand treatment. This page is editorial research and is notmedically reviewed by a clinician. Prices and policies change — confirm at checkout.
Frequently Asked Questions
- Can HRT reverse osteoporosis?
- HRT is not FDA-approved as a treatment that reverses established osteoporosis. Systemic hormone therapy can help prevent bone loss and reduce fracture risk for the right candidate, while treatment after a diagnosis is based on your overall fracture risk and usually uses a bone-specific medicine (The Menopause Society, 2022).
- Which estrogen is best for bone density?
- There is no single best estrogen. What matters is an FDA-approved, systemic product labeled for bone — examples include Premarin, Estrace, the patches Menostar, Vivelle-Dot, and Climara, and the combo Duavee. Your clinician matches the exact product to your history, route preference, and uterus status.
- Is an estrogen patch better for osteoporosis?
- A systemic estradiol patch can help prevent bone loss for the right candidate, and skin routes such as patches, gels, and sprays may carry lower clot risk than pills. It is prevention, not treatment of an existing diagnosis. Note: patches were in short supply in 2026, so ask about gel or spray as a backup (ASHP; NPR, 2026).
- Is vaginal estrogen enough for bone health?
- Most vaginal estrogen — Estring, vaginal tablets, low-dose cream — is local and not a substitute for systemic bone-directed therapy. The exception is Femring, a vaginal ring that is actually systemic, so the exact product must be identified (The Menopause Society, 2022).
- Do I need a DEXA scan before starting HRT?
- Not always for a prevention-focused menopause visit, but screening is recommended for women 65 and older and for younger postmenopausal women whose fracture risk is high. If you have had a scan, bring the result. A known osteoporosis diagnosis changes the plan (USPSTF).
- Can I start HRT after age 60?
- Age 60 is not an automatic no, but starting systemic HRT later needs a more careful, individual benefit-risk review. Continuing therapy you already take is a different decision from starting fresh just for bone protection (The Menopause Society, 2022).
- Can I start HRT more than 10 years after menopause?
- It is not an automatic prohibition, but the most favorable window for starting is within 10 years of menopause or before age 60. Beyond that, a clinician should weigh your personal risks — which is exactly when an in-person assessment can be worth it (The Menopause Society, 2022).
- Can a telehealth clinician prescribe a bone medicine like alendronate?
- Sometimes. Sesame, for example, lists common bone medicines on its platform — but a listing is not a guarantee, and a diagnosis of osteoporosis is best managed by a clinician who can review your scan and fracture risk. Ask any provider directly what they can and cannot manage.
- Do I need progesterone if I have a uterus?
- With systemic estrogen, yes — you need endometrial protection, usually progesterone or a progestin, or an approved estrogen-plus-SERM combo like Duavee that builds it in. A good clinician includes this; confirm it is in your plan (FDA).
- Is FDA-approved HRT better than compounded for osteoporosis?
- For bone, yes. Only FDA-approved products carry a bone approval, and the FDA does not verify a compounded product's safety, effectiveness, or quality before it is sold the way it does for approved drugs. Many FDA-approved hormones are also chemically identical to the body's own (FDA).
- Does insurance cover online HRT and a bone scan?
- It depends on your plan. Midi bills most PPO plans but not Medicare or Medicaid; FDA-approved generic hormones are widely covered; compounded products usually are not; and DEXA scans are often covered when screening is recommended. Confirm specifics with your insurer.
- Can HRT and a bone medicine be used together?
- They can be part of one coordinated plan in some cases, but that is an individual clinical decision — not something to self-assemble. If you are diagnosed, let a clinician decide whether HRT, a bone medicine, or both fit your fracture risk.
- What if I have osteopenia, not osteoporosis?
- Osteopenia means your bone density is below normal but not yet in osteoporosis range. The next step depends on your overall fracture risk, age, and other factors — not the scan number alone. An online menopause visit can be a reasonable place to start the conversation; high risk should involve bone-focused care.
- What if early menopause or primary ovarian insufficiency caused this?
- Early menopause and primary ovarian insufficiency carry distinct long-term bone effects and should not be treated like ordinary later-life menopause. These situations deserve age-appropriate care and often specialist input — bring them up directly rather than relying on a generic ranking (The Menopause Society, 2022).
- Is online HRT okay after a broken bone?
- If it was a fragility fracture from a minor fall, online HRT alone is not your starting point. That needs prompt, in-person bone evaluation and usually a bone-specific medicine. Telehealth HRT can join later (Endocrine Society).
Still Not Sure Which HRT Program Is Right for You?
You don’t have to settle this alone, and you don’t have to guess. Take our free 60-second matching quiz.Answer a few questions about your symptoms, bone history, insurance, and state, and get a personalized action plan — including a clear flag if your situation is one that belongs with an in-person clinician first.
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Related reading
Sources
Educational research compiled by The HRT Index. Medical and regulatory claims are traced to primary or highly authoritative sources; commercial figures to dated manufacturer, insurer, and pricing pages. Last verified June 25, 2026.
- FDA — FDA Approves Labeling Changes to Menopausal Hormone Therapy Products (2026); Menopause consumer page; Compounding and the FDA; estrogen product labels (Premarin, Estrace, Menostar, Vivelle-Dot, Climara, Duavee). fda.gov
- The Menopause Society (NAMS) — 2022 Hormone Therapy Position Statement (bone-loss and fracture prevention; not approved to treat osteoporosis; under-60 / within-10-years window; route and risk). menopause.org
- Endocrine Society — Pharmacological Management of Osteoporosis in Postmenopausal Women (high fracture-risk treatment; bisphosphonates as common initial therapy). endocrine.org
- British Menopause Society / RCOG (2022) — first-line osteoporosis treatment. thebms.org.uk
- U.S. Preventive Services Task Force — osteoporosis (DEXA) screening recommendation. uspreventiveservicestaskforce.org
- Cleveland Clinic Journal of Medicine — transdermal estradiol products approved for osteoporosis prevention.
- ASHP drug-shortage bulletin; NPR; NBC News; AARP (2026) — estradiol patch shortage and FDA-approved alternatives.
- Provider pages and 2026 reviews — Midi Health (joinmidi.com), Sesame (sesamecare.com), Hers (forhers.com), Winona (bywinona.com; Help Center FDA-status page). Commercial figures checked June 25, 2026; confirm at checkout.