What would you do? Medication.

@babs10 Forteo builds quality bone. It is an anabolic. Prolia, on the other hand, is an anti-resorptive which affects turnover. It is very hard to get off, and my docs try to avoid using Prolia at this point because of the intense rebound.

In my experience falls have not caused fractures. Instead twisting and bending do. But that's me. I did have a spinal fracture a long time ago from a truly traumatic fall when my back landed on the corner of steps, but my DEXA was okay then. I used to think the same way: I fell and nothing happened so my bones must be okay. Then I made one unwise movement (with DEXA's similar to yours) and got 2-3 lumbar fractures- so painful and disabling. I only say that to encourage you to try a med!

Forteo is a good drug. You follow it with Reclast or Fosamax, but those "lock in" gains and you can probably take a med break after one or two doses. If you for any reason cannot tolerate Forteo, you might get authorization for Tymlos, which I prefer because the dose is adjustable and can be ramped up. But many tolerate Forteo just fine. These meds both give excellent gains.

You can do a trabecular bone score with a DEXA to ascertain bone quality if you can find a place that does that, but with -3.5 not sure how relevant that is!

You might want to look into Keith McCormick's book "Great Bones" or Dr. Ben Leder's video "Combinations and Sequencing" on YouTube.

I am a fan of Tymlos. I am struggling with Evenity. Grateful for my two years on Tymlos and Forteo is similar. For either the companies also offer financial assistance if you meet income guidelines. I got 18 months of Tymlos for free.

I completely understand your dilemma, as it is similar to mine. Also 68, active runner for years, good diet, etc. My lumbar score is -3.2 with hips just around -2. I’ve watched the density steadily decline over the last 17 years and refused to take any meds…..yet. Like you, I’m trying to kick that down the road as long as I can. I’ve also taken a few significant tumbles and have never fractured. My last scan was 2022, and I have scheduled REMS next week, followed by a DEXA, vertebral fracture assessment and TBS next month. The last 18 months, I drastically stepped up my strength training, with a personal trainer, added Vitamin K, increased Vitamin D, added Magnesium, and paid closer attention to my Calcium intake through food. I’ve also worked on eating more protein and cutting back on foods high in oxalates. If those changes haven’t at least slowed the decline, I am leaning toward trying Strontium Citrate, but not confident about that yet. But if the density has continued to drop significantly, I will consider Tymlos. It will cost me $750 a month out of pocket, but I am encouraged that the dose can be adjusted if need be. So, I am waiting, my doctors are relatively tolerant of my decision, but strongly encourage medication, of course. They know I am doing thorough research and trying to be as healthy and strong as I can be. I’m not ignoring it; I know it’s serious; but I am trying very hard not to let it define me or limit the things I enjoy.

You are a wealth of information and encouragement for trying Tymlos. I appreciate all the information you share. I consider you a role model if/when I go down the medication route! Thank you!

Thank you so much for weighing in. Since my insurance only covers Forteo (after rejecting Prolia), I might be stuck. Maybe doctor's can appeal if there is a bad reaction? I weigh 125 pounds and recently read a post somewhere that rightly said people at 125 lbs shouldn't have the same dose as someone who weighs 170 lbs so being able to adjust the dose does make good sense with the Tymlos.

I haven't read Keith McCormick's books yet, but have watched some of his videos. I find him especially credible because he is not straight anti-medication. He understands that some people need and will benefit from it. Do you happen to know if he ever took any medication? I'm not clear on that.

I don't meet he income guidelines for Forteo so my fee is going to be $1920 a month. Let that sink in...absurd. There is a cap of $8000 and nothing due after that, but our system needs an overhaul, that's for sure.

Thank you so much for weighing in. Much appreciated.

From what I've gathered, past fracture(s) matter and/or a family history of fracture matters quite a bit. What's your 10 yr frax score for major osteoporotic fracture as well as hip fracture? When they are at or greater than 20%(major) or 10%(hip) respectively, it's time to seriously consider pharmaceuticals, mostly likely with an anabolic first. Some other conditions such as inflammatory diseases, chronic cortical steroid usage etc. are also taken into consideration. Generally t score of femoral neck is the one that's more indicative for potential future fracture. Majority of the fractures are results of a fall, so fall prevention is number one priority for osteoporosis patients. This might mean some of us have to give up activities that involve high impact and/or make us prone to fall 🙁

I have heard of the Strontium Citrate, but know nothing about it. I gather this would be in place of medicine. Is that the decision - S.C. or medication?

OP is such a complicated problem, isn't it? You feel great until you fracture. Ugh.

I'm looking for a personal trainer, but so far haven't found anyone who knows anything about how to keep people with OP safe. I am going to call Medicare and see if they would cover PT for me for a bit. I can learn the exercises and do them myself if I have to, but a personal trainer would be so much better.

Thank you so much for your post, glojo.

Yes, I will either do SC or Tymlos, but just cannot commit to either yet. Right after my previous DEXA, with the -3.2 lumbar score, I sought out a physical therapist because I wanted to make sure I was moving properly and to work on posture and balance, and I had some consistent back soreness, not pain, and was terrified of fracture. She helped me get past all of that fear, and reassured me that I was in good shape. Medicare covered every visit with the therapist, and I saw her twice weekly for about three months. It’s all in the way their business office codes it, I guess. Then I found a smart personal trainer who didn’t have a lot of experience with osteoporosis, but did work with older clients with health problems. By then, I had done my homework about how NOT to move, and together we worked out a plan. He LISTENS and also does his homework, so it’s been tremendously helpful for my strength and my confidence. I work with him once a week….it’s not cheap…and follow up on my own at home two or three more times a week. This is the best thing I ever did for my bones and my overall health.

No kidding on the high impact and prone-to-fall activities. I gave up snow skiing this year because of it. To be honest, I'm feeling a big afraid to do anything at all, but have to get over that.

Here are my scores:
LUMBAR SPINE:
T-score = -2.4
Z-score = -0.5

FEMORAL NECK:
T-score = -2.2
Z-score = -0.5

TOTAL HIP:
T-score = -3.5
Z-score = -2.1

FRAX-WHO Fracture Risk Assessment Tool: Treatment is recommended for
patients with a FRAX score (risk calculation) of greater than 20% risk
for major osteoporotic fracture and greater than 3% risk for hip
fracture.

This patient's 10-year probability of fracture calculated by FRAX is:
Major Osteoporotic: 18%
Hip Fracture: 3.5%

Thank you for responding.

We are twins in some ways. 🙂 You are a bit ahead of me. I'll call about PT and hope to find a trainer as you have found.

@babs10 the discussion about weight and dosing was about Evenity. And I think the optimal dose for that is the full dose, though I have had some trouble tolerating it.

When I came on this forum and described using the adjustable dosing for Tymlos, my goal was still the full 8 clicks on the pen (80mcg). I used the adjustable dosing to ramp up. The goal is still to get as high as you can. You will still have some side effects, potentially, for an hour or two- it is about tolerability. Most don't seem to even need to do this. I am sensitive. If you tolerate Forteo, which most do, great (except for the cost, but there is now a generic). If you don't tolerate it, I would think your insurance would then cover Tymlos. Let us know!

Keith McCormick did Forteo then one dose of Reclast I believe. And then more holistic/"whole body" approaches. I think he had something like 22 fractures. He was/is a triathalon athlete. I believe some of the fractures were in his feet. I asked him about this and also heard it in an interview.

@glojo and others there is nothing "natural" about 680mg of strontium, the therapeutic dose. It is hugely more than what we ingest normally. It will make the density on DEXA look better than it is, because strontium replaces calcium in bone and is denser. Finally, the European version of the FDA banned it for a short time in the ranelate form due to cardiovascular risks. We don't know if that is true for the US supplements. In Europe it was reinstated as an option for those not at risk of cardiovascular events and who cannot take anything else but have serious osteoporosis.

I started it a long time ago, when I couldn't tolerate any meds. I would not take it now, but that is me.