What would you do? Medication.

Most of the posts relate to fractures following a fall and I’m wondering if anyone else has experienced a spontaneous osteoporotic fracture. My 1st one- a left pilon fracture occurred after I walked around an art fair for hours (more walking than usual) on level surface and required surgery. The 2nd one occurred 2 days after the pilon fx surgery when I started to stand up from a chair and fractured my right patella in half (full disclosure that knee had a replacement a year prior). At the time of these fractures I had been on Prolia for 18 months. Was started on Tymlos 3 months later.

@babs10- I agree with you on your choice of Millman!! . I am about to start meds but want to really understand my root causes so I can do all I can to assist my situation and once a hopeful 3years or so on meds , I can be , and stay in a good place with my bone health ongoing into the future. Would love to hear your feedback if you do fly to see her. Good luck!!

Gosh! That must have been shocking for you! How are you doing on Tymlos?

I think twisting and contorting are more of a risk than falls, from my personal experience. And opening windows, bending over to lift things, etc. Excessive weight too.

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 had a mountain bike accident five years ago. I was going down a steep slope at a fast pace, and my front wheel slid sideways into a rut. I reflexively grabbed both brakes and got launched over the handlebars. I probably traveled 10 feet through the air, and dropped at least 8 feet onto hard-packed dirt and rock. The impact was violent, and it fractured my pelvis in two places. Search and Rescue had to come get me, I was out in the middle of nowhere. But, three weeks later, I walked away, whistling, all healed. It was like it had never even happened! No pain since. And the ER doc and the orthopedist said, "Man, you must have strong bones!" So, I tucked away the idea of a DEXA, having been bucked off horses, fallen out of trees, you name it. I never smoked, drank very little alcohol, didn't drink soda, no stomach problems, one cup of coffee a day, ate cheese, yogurt, tofu, drank milk, and ran thousands of miles training for marathons. Took karate, did yoga, played every sport and was just very active in general. I even went through a period in my 20s where I ate lots of sardines on crackers!
My mother is 92, and she played tennis until she was 80. She fractured her ankle getting out of her hot tub 2 years ago, and the surgeon said she had great bones.

Fast forward to Jan 15th, 2024. Went out to ski a few runs with my husband (we live at Lake Tahoe). On the first run, I got caught on my outside ski edge and was headed toward some fencing. In order to stop, I simply sat down. Immediately got back up and skied away. No pain, nothing. But in the next few runs, something wasn't quite right. My legs felt weak, and I was having trouble controlling my skis. I thought I was just having a bad day. I do squats and lunges to keep my legs strong, for skiing, so it was a little strange. Nothing more for a week, but then mid back started feeling tight, then went into massive spasms. The pain was so intense, worsening when I tried to lie down. I got no sleep at all. I had never had back trouble, so I was mystified.

Long story short, I went to work (I'm a physician at a university student health clinic) and got diagnosed with an L1 compression fracture. Subsequently had a DEXA which showed osteoporosis in both spine and hips, spine the worst w/ T score -2.8, and left hip -2.6. I can't begin to tell you what an insane surprise this was. I sat in my car after the DEXA trying to digest the results. My husband doesn't believe it, and my little brother was incredulous. They've seen me just thrash myself for years.
I alternate between feeling depressed (I went skiing and turned into a decrepit little old lady) and feeling searing rage at the universe (how dare this happen when I have tried to live a healthy life).

I started piecing things together. My only real risk factors are being a slender blonde, and stopping hormones when the Women's Health Initiative suggested it wasn't a good idea to continue them after menopausal symptoms stopped. Well, well, well, the Women's Health Initiative, who served up a big kettle of bullshit stew, and the medical world lapped it up. Never mind that the findings were totally debunked later, it was that sensational headline: "Estrogen in menopause causes breast cancer, heart disease and dementia!" was blasted across the front pages of newspapers around the world. Had we all lost our minds? Something that courses through your body from the onset of menses to menopause is suddenly a deadly poison? But it was taken to heart by the medical profession, and most people never bothered to check further.
For an interesting book about how much we need estrogen, check out "Estrogen Matters" by oncologist Avrum Bluming, MD and psychologist Carol Tavris. They go over in detail the link between estrogen and breast cancer (there isn't one) and how much women need estrogen to live long healthy lives and most importantly, keep their skeletons strong.
The difference between my 92 y/o mother and I? She had her uterus yanked out (didn't everybody's mom have that back then?) and was PUT ON ESTROGEN and took it for years. I had it for 2 years and then stopped because of the good ol' Women's Health initiative misinformation.
I attempted to restart it about a year ago because I was having a drop in my sex drive and experiencing "vaginal dryness." That's a euphemism for actually feeling like your vagina was sanded down with a Brillo pad and then finished off by a blow torch after having sex. When I mentioned restarting it to the young male gynecologist I saw for a Pap smear (my older doctor had retired), he was alarmed. "No, " he said, "I've seen too many cases of cancer!" and then, unbelievably, followed that with, "If you're having a drop in your libido, maybe you should see a sex therapist." I was too stunned to reply. I've been sleeping with the same guy for 40 years; I think we have it dialed in by now.
Part of me wonders about how older women are perceived, it's like, you old harpy, your child-bearing days are over, why would you even need to have sex? Meanwhile, there are pills, pumps, creams and injections all to help men achieve erections. But women? Just be quiet and cook dinner, then go fall off a cliff, why dontcha?

Anyway, sorry for the long rant. I just want to say that we should be open to anything in terms of helping our bones. I am now on a full dose of estrogen and progesterone, taking Evista because I couldn't wait to start something, and the osteoporosis specialist I saw is getting Tymlos for me, because unlike Forteo, it doesn't have to be refrigerated. Both those drugs are anabolic; they build bone. Then I will take something like a bisphosphonate to maintain my newly built bones. My kitchen counter is littered with many types of calcium supplements and Vitamin D3 with K2, but that's not new. I have been taking BoneUp, and vitamin D3 for years, not that it seems to have done much good. And I can't tell you how many docs I have seen over the past 20 years for this or that, including Paps and preventative visits and not ONE ever suggested that I needed a DEXA scan. A slender blonde, who was resting on her laurels because she had no family history and a rough and tumble past. So I can blame myself, too.

It's so frustrating. You didn't mention your age - I'm wondering b/c of the estrogen and progesterone. Yes, seasoned women are easily and readily dismissed. It's infuriating. Glad you are ok.

To the stat that 1 in 8 women will get breast cancer, that’s a scare statistic! 7 of 8 won’t get breast cancer! And, the stats are relative to age! I wish I could post pic from book written by oncologist about real breast cancer risks. My breast surgeon thinks I should have been on hrt it for a long time, but my endocrinologist scared me away,
Also, with use of bone drugs, you have to look at absolute risk reduction as opposed to the sales pitch, of relative risk reduction if you really want to compare benefits vs. side effects. I know it’s depressing to read that absolute risk reduction isn’t very good, but taking meds, with for some people, possibly bad side effects, risking low BP and dizziness causing falls, no exercise tolerance, and possible cardiac effects down the road just doesn’t make sense to me for most people. Uninformed doctors and big pharma are selling false hope imho. And, don’t get me wrong, I think big pharma does some things well. Unfortunately, in life sometimes we learn that there isn’t always a great fix to things. Hard to deal with and we have to do the best we can. It’s unfortunate that we have to do so much research ourselves, but thankful for this forum of people who do it!