1. < Osteoporosis & Bone Health

Should I use an anti-resorptive agent after Forteo?

Posted by 06111945cc @06111945cc, Mar 2 11:59pm

Excerpt from https://www.inspire.com/groups/bone-health-and-osteoporosis/discussion/p1np-bone-markers-and-forteo/

"Some experts, like me and Bob Lindsay and Felicia Cosman in the US often prefer to treat pstients with an elevated risk of fracture with 2 separate 1-year courses of Forteo, usually separated by a 3-4 months treatment with an anti-resorptive agent such as estradiol, or oral alendronate sodium 35-70 mg per week, or a single infusion of ibandronic acid 3 mg (but NOT zoledronic acid, because it lasts so long), as opposed to a single 2-year course of Forteo. It's likely to be a bit more anabolic (bone building)."

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babs10 | @babs10 | Mar 3 8:37am

SUCH a helpful and interesting Inspire back and forth. Thanks for sharing the link.

I hadn't heard of either MD so looked them up. Here is Felicia Cosman for those who may be interested. https://www.getwellen.com/well-guide/ask-the-expert-felicia-cosman-md

and here is an OsteoBoston presentation with Dr. Lindsay: https://www.youtube.com/watch?v=zG_V6XPIDFU - clear/fascinating.

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2 replies
mayblin | @mayblin | Mar 3 8:53am

Hi @06111945cc my understanding is one year after forteo treatment, most ppl would lose what's gained on the drug. So an antiresorptive is essential if you want to preserve what's gained. How far along are you with forteo? Is your doctor willing to do off label use? With the short comings of btms, you'd have to have your doc on board should you consider other unconventional route.

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06111945cc | @06111945cc | Mar 3 9:07am
In reply to @babs10 "SUCH a helpful and interesting Inspire back and forth. Thanks for sharing the link. I hadn't..." + (show)
@babs10

SUCH a helpful and interesting Inspire back and forth. Thanks for sharing the link.

I hadn't heard of either MD so looked them up. Here is Felicia Cosman for those who may be interested. https://www.getwellen.com/well-guide/ask-the-expert-felicia-cosman-md

and here is an OsteoBoston presentation with Dr. Lindsay: https://www.youtube.com/watch?v=zG_V6XPIDFU - clear/fascinating.

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👍

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06111945cc | @06111945cc | Mar 3 10:31am
In reply to @babs10 "SUCH a helpful and interesting Inspire back and forth. Thanks for sharing the link. I hadn't..." + (show)
@babs10

SUCH a helpful and interesting Inspire back and forth. Thanks for sharing the link.

I hadn't heard of either MD so looked them up. Here is Felicia Cosman for those who may be interested. https://www.getwellen.com/well-guide/ask-the-expert-felicia-cosman-md

and here is an OsteoBoston presentation with Dr. Lindsay: https://www.youtube.com/watch?v=zG_V6XPIDFU - clear/fascinating.

Jump to this post

Thank you!

I really enjoyed Dr. Lindsay‘s presentation.

CC

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Michael Lavacot | @michaellavacot | Mar 8 5:30pm

Hello @06111945cc

I have one datapoint for you on the proposed intermittent Forteo (Teriparatide). Below is a slide from a Dr. Michael McClung presentation at the 2023 World Congress of Osteoporosis that shows a study of Forteo used on and off for 4 years without treatment between breaks. The study is listed at the bottom of the slide. It might make sense to use a bisphosphonate like alendronate in-between breaks, but I have no data here. If you do, perhaps you can share.

Mike
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2 replies
mayblin | @mayblin | Mar 8 8:14pm
In reply to @michaellavacot "Hello @06111945cc I have one datapoint for you on the proposed intermittent Forteo (Teriparatide). Below is..." + (show)
@michaellavacot

Hello @06111945cc

I have one datapoint for you on the proposed intermittent Forteo (Teriparatide). Below is a slide from a Dr. Michael McClung presentation at the 2023 World Congress of Osteoporosis that shows a study of Forteo used on and off for 4 years without treatment between breaks. The study is listed at the bottom of the slide. It might make sense to use a bisphosphonate like alendronate in-between breaks, but I have no data here. If you do, perhaps you can share.

Mike

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Hi Michael, this is Dr. Cosman's work right? Do you know if Dr. McClung is doing the cyclic method off label clinically (or is this method used clinically off label by any doc?)? Thanks

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1 reply
sallyj2 | @sallyj2 | Mar 9 10:54am

There are other doctors using the cyclic method who use hrt during the off periods and others who use hrt the entire time while cycling parathyroid hormone. As mentioned, the thought process is the parathyroid hormone works best during the first few months plus it can be used over a longer period of time. It’s intriguing! Maybe fewer side effects?

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1 reply
mayblin | @mayblin | Mar 9 11:38am
In reply to @sallyj2 "There are other doctors using the cyclic method who use hrt during the off periods and..." + (show)
@sallyj2

There are other doctors using the cyclic method who use hrt during the off periods and others who use hrt the entire time while cycling parathyroid hormone. As mentioned, the thought process is the parathyroid hormone works best during the first few months plus it can be used over a longer period of time. It’s intriguing! Maybe fewer side effects?

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Hi sallyj2, could you give a link re using hrt as a background vs using hrt for off period for the cyclic method, when you get a chance? I’m very interested in reading how the end results would differ. Thanks a lot!

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1 reply
Michael Lavacot | @michaellavacot | Mar 10 10:20am
In reply to @mayblin "Hi Michael, this is Dr. Cosman's work right? Do you know if Dr. McClung is doing..." + (show)
@mayblin

Hi Michael, this is Dr. Cosman's work right? Do you know if Dr. McClung is doing the cyclic method off label clinically (or is this method used clinically off label by any doc?)? Thanks

Jump to this post

Best I can tell, Cosman published in 2015 and was for 24 months. This paper was by Ganapathy in 2023 and went 48 months. I can't seem to find the trial data though. Maybe it was an extension study of the Cosman data. Not sure.
I have no idea if McClung is doing this clinically, he was just presenting different studies of intermittent treatments.

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