Hi @gently. Thank you for your explanation. I didn’t sleep last night worrying about it. I will do a little more research and probably go ahead as your comments make sense and my current endocrinologist mentioned forearm loss but not hip loss (maybe for that reason?).

I’ve thought about my options for 8 months before deciding to go on Forteo. The premise to build bone then lock it in is logical. But now I’m going back to what my long term endocrinologist said (he is just retired) …. I may never need an anabolic, I just need to stop my recent rapid loss (-2.4%) per year in the past two years. I’m 65 years old and before then my T-scores were fairly stable around -2.5 to -2.8 for the past 15 years. I believe the recent drop was due to lack of exercise (Covid), and drinking too much wine (caregiver for dying parent during Covid) and cutting out a large portion of my daily calcium with intermittent fasting (no breakfast yoghurt/berries/milk/nuts) to lose the weight I gained from lack of exercise and the wine!!! I’m back to my normal exercise routine (4X per week of weight training for at least an hour, plus sport activities and lots of dog walks), and I’m only drinking a few glasses of wine a week. Plus I’m super careful about getting my calcium through diet and when I don’t I make sure I supplement. I just hope I’m not doing an anabolic unnecessarily in case I get a random side effect like tinnitus, or hair loss/belly fat or something worse like decreased strength in my forearm or hip.

This disorder is a tough one. With no symptoms or fractures from it, it is hard to agree to a medication that can screw up what’s not yet screwed up. Especially since so many people say DEXA’s aren’t accurate. I’m basing going on this drug, because of my DEXA score, so when you put those two together it is kinda scary. I had a REMs/Echolight and my density score in my spine was better than with the DEXA (-2.6 vs -3.1). Hip was the same. But their bone quality score has mine in the green and I’m a petite woman, so maybe I’m not at a high risk? So many difficult questions with no concrete answers. I still feel I should probably give Forteo a try, as my goal is to increase my bone density/strength so I can continue to do my sports (ski) for as long as possible with more bone safety.

@gently that is a very interesting comment:
"The slightly more porous bone resists fracture because it is more flexible. Density and strength are sometimes in opposition"

I have wondered about this. Especially on Evenity. Incrreased bone density seems to have made me stiffer and I have more issues reaching, for instance. I wonder what happens to compressed vertebrae as bone density increases. With Evenity I also wonder about increased arthritis and bigger bone spurs! I am just speculating so don't want to cause concerns. My situation is different from most with several compression fractures. And a lot of this "wondering" is theoretical!

Hi gently,
I have been curious about that. I have a very small frame and though if my bones get too dense they might be less flexible. I wonder if that is true for tymlos as well.

@gently Could you please provide references for your statements about Forteo creating an improvement in bone by slightly increasing porosity. I think I might have once seen speculation that maybe it's ok somehow to have a slight bone loss in hip or forearm with Forteo and that eventually as you get further along in your treatment period the density will increase. My memory is hazy on that and may not be accurate but I don't believe I've seen anything suggesting that any osteoporosis med is increasing bone strength while decreasing density.

Regardless I'd love to see references showing that bone loss in the hip or forearm with Forteo is really ok. Thanks