What would you do? Medication.

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.

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.

At 68, T score is relevant here and to be considered. Anyone please correct me if this is wrong. Yes, most guideline suggest when frax probability greater than 20% for major or 3-5% for hip, drug therapy to be considered. I mentioned to consider drug therapy when 10% for hip frax probability in the previous reply, is from a specific reading according to an experienced bone doctor. Maybe we should just follow the general guideline here. There is an yt video "anabolic therapy for osteoporosis by felicia cosman" by endocrine society of india official, in which she lays out risk stratification, low total hip BMD belongs to high risk and she gave specific numbers. You could look into that. Cosman has done tremendous amount of work with forteo along with others. My video resolution is very poor for some reason hence I won't attach the link. Maybe same talk by a different video source would give a better resolution. Your frax probabilities for major overall and hip are both near where medicine should be considered...From what I've read, tymlos has a bit advantage over forteo in improving hip/femoral neck. However, a lot of times our insurance as well as our body's response (side effects etc) dictates which drug is to be used.

BTW, I forgot to mention that to protect spine from compression fractures, our posture including twisting upper body and/or exertion with certain posture make a big difference. I garden quite a bit, and have modified quite a bit of my posture ever since my diagnosis.

Best

At 68, T score is relevant here and to be considered. Anyone please correct me if this is wrong. Yes, most guideline suggest when frax probability greater than 20% for major or 3-5% for hip, drug therapy to be considered. I mentioned to consider drug therapy when 10% for hip frax probability in the previous reply, is from a specific reading according to an experienced bone doctor. Maybe we should just follow the general guideline here. There is an yt video "anabolic therapy for osteoporosis by felicia cosman" by endocrine society of india official, in which she lays out risk stratification, low total hip BMD belongs to high risk and she gave specific numbers. You could look into that. Cosman has done tremendous amount of work with forteo along with others. My video resolution is very poor for some reason hence I won't attach the link. Maybe same talk by a different video source would give a better resolution. Your frax probabilities for major overall and hip are both near where medicine should be considered...From what I've read, tymlos has a bit advantage over forteo in improving hip/femoral neck. However, a lot of times our insurance as well as our body's response (side effects etc) dictates which drug is to be used.

BTW, I forgot to mention that to protect spine from compression fractures, our posture including twisting upper body and/or exertion with certain posture make a big difference. I garden quite a bit, and have modified quite a bit of my posture ever since my diagnosis.

Best

It’s tough to know what’s right. Spinal compression fractures concern me the most. But as you mention @babs10 the meds over time are concerning, too.
I’m 69, family history of osteoporosis. I’m mostly a moderate exerciser, but my diet has always included calcium, protein, and I get enough D. My doctor wrote prescriptions for oral alendronate in my late 50s for osteopenia but I hesitated over expectations of stomach issues.

At 67, with osteoporosis, I finally did take it, and couldn’t tolerate it. I had a Reclast infusion in July 2023 and by November 2023 had a 6% increase at spine. The rheumatologist and bone specialist I see at MD Anderson is happy with my numbers, see attached, and recommends that I do another Reclast in 2024, then maybe every other year. I also see a local endocrinologist who does the actual order/infusion for Reclast.

My mother (osteoporosis) and two older sisters (osteopenia) have never broken a hip - even with some falls that would have caused broken bones in many others. My mother did have some compression fractures in her back, diagnosed at about age 86. Some of the bone density drugs are better at building/preserving the spine, others build more femur/hip bone.

I will definitely continue to take what my doctor recommends as these drugs deter bone metastasis if breast cancer spreads. That’s worth it to me.

@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.