Loss of BMD in hips after taking Forteo or teriparatide?

I don’t know how accurate REMs is, but according to my scan two months ago, my osteoporotic bones are still in the green zone (good) with respect to quality, albeit at the cusp of the orange zone. At least I was no where near the red! My first TBS score on April 9 will be interesting!

sallyj2,
I'll write what I really think with liberty because it's April Fool's Day.
Forteo might be safer than Tymlos because the dose is so much lower (4x). Forteo at 20mcg is (I would say "Likely", but am forbidden that word on this forum, so) perhaps, too high a dose for many of us (lightweights).
Osteoclasts clean the bone before osteoblasts lay down new bone. These cells are said to work most efficiently when coupled. The nature of Tymlos' attachment to the bone allows for an earlier uncoupling of the clasic/blastic team.
While neither of these drugs poses great risk, there is the risk of complication because of co-diseases. And there is a risk of allergic reaction.
Tymlos contains preservative, which is why it doesn't need refrigeration, that increases the possiblility of allergic reaction. Since you can quickly stop taking either of these drugs, they are safter than drugs that persist in your body for months. But there are many brave souls who work at tolerating these side effects.
Finally, it is in my mind, that a slower development of new bone provides an opportunity for the bone to become seated--settle more deeply into the bone matrix where osteoblasts mature into osteocytes. Osteocytes are said to be the cells that remodel our bones making them more flexible specifically in response to our activities.
Bisphosphonates are safe for most. And they have prevented many more fractures than they have caused. I'd sure take them if there weren't the anabolics. I'd prefer to keep bone gains recycling than hold those gains. I think there is a perfect balance of osteoclast/osteoblast acheivable through more intermittant dosing of Forteo. After Forteo I plan on more forteo.
Don't be fooled by my thinking. I may recognize the shortfall on my next dxa, or the one after, or by one of those painful fractures.

@gently @sallyj2 @lynn59 I'd like to throw in my two cents here.

Forteo and tymlos are sister drugs as we know. On the quest of figuring out my initial puzzling 13mo forteo results, I've read many theories and explanations regarding the increased cortical porosity by forteo and the consequences of it. Do you know forteo increases cortical bone thickness? Actually tymlos does it too, with less intensity due to its altered receptor binding configuration. In most clinical studies, tymlos showed a slight advantages in the reduction of fracture risk, as well as in btm% increase. When you think about this further, the question arises: why would the porosity increase by forteo (in 1/4 of relative dosage in comparison to tymlos) ended up a closeup in terms of fracture risk reduction, and bmd increase? If increased cortical porosity is strongly associated with a weaker bone (in adults), then the results presented in numerous clinical studies wouldn't show that forteo has a statistical significance in fracture risk reduction. So we need to put the concern of porosity increase in a right perspective here. As far as my hip and femur neck results at 13 mo of forteo, dexa showed no change. I wonder if this is because I had a base t score at osteopenia range hence less room for improvemnt. The result could also be looked at another way: the no change is great because without forteo, I'd have further 1-3% yearly loss instead. So forteo kept my hip and femur bone stable. Im quite happy with forteo so far as far as side effects go: only initial low blood pressure for 1.5 mo, nothing else! You can read there are many other people got great improvements in hips and or femur neck with forteo. Usually it is the negative news that catch our mind the most, unforturnately.

Choosing a drug is so personal and sort of like gamble here too. One drug that worked great for one individual doesn't mean it will work the same for the next. Our personal believes, health status and preferences all play a role. Unexpected side effects will throw us off too and force us to make a change. Then there is insurance coverage... the best drug is the one works for us. But before you try one, you really don't know that perfect drug for you, forteo or tymlos.

@gently @sallyj2 @lynn59 I'd like to throw in my two cents here.

Forteo and tymlos are sister drugs as we know. On the quest of figuring out my initial puzzling 13mo forteo results, I've read many theories and explanations regarding the increased cortical porosity by forteo and the consequences of it. Do you know forteo increases cortical bone thickness? Actually tymlos does it too, with less intensity due to its altered receptor binding configuration. In most clinical studies, tymlos showed a slight advantages in the reduction of fracture risk, as well as in btm% increase. When you think about this further, the question arises: why would the porosity increase by forteo (in 1/4 of relative dosage in comparison to tymlos) ended up a closeup in terms of fracture risk reduction, and bmd increase? If increased cortical porosity is strongly associated with a weaker bone (in adults), then the results presented in numerous clinical studies wouldn't show that forteo has a statistical significance in fracture risk reduction. So we need to put the concern of porosity increase in a right perspective here. As far as my hip and femur neck results at 13 mo of forteo, dexa showed no change. I wonder if this is because I had a base t score at osteopenia range hence less room for improvemnt. The result could also be looked at another way: the no change is great because without forteo, I'd have further 1-3% yearly loss instead. So forteo kept my hip and femur bone stable. Im quite happy with forteo so far as far as side effects go: only initial low blood pressure for 1.5 mo, nothing else! You can read there are many other people got great improvements in hips and or femur neck with forteo. Usually it is the negative news that catch our mind the most, unforturnately.

Choosing a drug is so personal and sort of like gamble here too. One drug that worked great for one individual doesn't mean it will work the same for the next. Our personal believes, health status and preferences all play a role. Unexpected side effects will throw us off too and force us to make a change. Then there is insurance coverage... the best drug is the one works for us. But before you try one, you really don't know that perfect drug for you, forteo or tymlos.

I am not sure the dosage of Forteo and Tymlos can be compared so easily since they work a little bit differently.

@mayblin posted this: I cannot find the source 🙂

For fair comparison, a 20mcg forteo is more or less comparable to a full dose of tymlos at 80mcg, not at a lower dose, although tymlos dose could be adjusted/titrated for those who need it due to severity of side effects. To be fully effective against future fracture, you might be needing a full dose of tymlos, 80mcg.

@windyshores this is not a quote, rather, its a observation or preliminary conclusion that I made after reading various clinical trials. Forteo marketed dose is 20mcg, deemed as minimum safe and effective dose to general population. There are higher doses tested according to Lilly, but 20mcg achieve the primary goal, that is, reduction of fracture risk, with secondary goal being increase in bmd, with statistical significance.

Forteo's molecule is a 34 amino acid peptide, an exact sequence (1-34) to that of natural parathyroid hormone, which contains 84 amino acid. By comparison, tymlos contains 34 amino acids also, but it's a synthetic analog of natural human parathyroid hormone, i.e., its component of amino acids differ from that of forteo. So maybe we are comparing dark green apples to light green apples here. Because the difference in amino acid composition, we could get the molecular weight of each drug for a comparison. To be more precise, we could use mmol for comparison. My guesstimate is that since both have 34 amino acids, weight wise will be approximately same. Using mmol, we are looking at a lot more abaloparatide (80mcg converted to mmol) molecules vs teriparatide (20mcg converted to mmol) to achieve approximate similar results, with abaloparatide in a slight advantage. That's my deduction. Research paper often cites that the reason for tymlos's advantage is due to its altered configuration of binding at receptor site. This puzzles me because why it takes 4x as many molecules of abaloparatide/tymlos to achieve approximate same clinical results when compared to teriparatide/forteo? If tymlos’ slight better clinical results can be explained by altered receptor binding configuration hence earlier uncoupling, the required 4x more molecules/peptides for tymlos makes me wonder why.