Loss of BMD in hips after taking Forteo or teriparatide?

Are you able to take Tymlos? Tymlos and Forteo are so similar but Dr. McCormick wrote in "Great Bones" that cortical porosity is less affected by Tymlos. That said, your hip score isn't that bad and Forteo is a great medicine, according to many on this forum. Was Evenity discussed at all?

Tymlos isn’t available in Canada. Evenity is a little too new for my comfort zone given I have family cardiac issues. My endocrinologist said they aren’t sure about its cardio effects yet. I’m just not sure I’m bad enough for these extreme drugs. I’m having second thoughts!!!

There is scientific evidence that the lower density with Forteo reflects a cortical porosity. The slightly more porous bone resists fracture because it is more flexible. Density and strength are sometimes in opposition
You might ask for bone markers to make certain that Forteo is working for you rather than waiting for a DXA. P1NP and CTX.
Anabolics are just better medications. Actonel and Reclast preserve older bone. And will blunt the effect of the anabolics if you take them first. Prolia is a hazardous medication.
Teriparatide (Osnuvo?) is a really nice drug. I think you'll have great luck with it.

Why do you say “ Prolia is a hazardous medication?”

CC

Mornin' lynn59,
I take it that you too are in Canada?
I am about to commence Forteo on April 18.
Had nasty side effect of recurrent chest infections on Prolia.
Presently I am awaiting my drug insurance company, Canada life, to
know how much cost they will cover.
May I ask how much you are paying for Forteo?

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.

Good morning Christine. Since I just turned 65 years old, certain drugs are covered by my provincial health care plan (OHIP as I live in Ontario). I qualify for a bio-similar drug to Forteo, called Osnuvo, so I will pay nothing. I could potentially apply to get the brand name, Forteo, but it is unlikely I’d qualify as I haven’t fractured a vertebrae, nor have I tried any other drug that wasn’t effective.

It is my understanding that Osnuvo (made in Quebec as of last year) costs around $560-$700 per month if you have to pay out of pocket. I heard (not verified) that Forteo is around $1200-$1500 per month, but I’m wondering if that price will come down. I’m guessing Forteo had a 20 year patent, and if I’m right that would have expired two years ago. I’m guessing that is why we are seeing bio-similiars out on the market in the past year. Maybe Forteo will lower its prices to compete better, especially since most of their initial research costs are likely already covered? Let me know what you find out! And if you are comfortable, you can always go to Osnuvo.

@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.

@candy209 I felt good on Tymlos, but Evenity seems to be making me stiffer. Low sclerostin does play a role in joints/arthritis but this is more, for me, about how my spine feels (and I have several fractures).