1. < Osteoporosis & Bone Health

Loss of BMD in hips after taking Forteo or teriparatide?

Posted by lynn59 @lynn59, Mar 29 9:14pm

I’m scheduled to start a biosimilar to Forteo in a couple of weeks and I just read a post today from a woman who lost bone density in her hips after being on Forteo. I got interrupted and couldn’t find the post again, so I’m asking the question here as now I’m afraid to start. My T-score in my spine is -3.1 and my hips are -2.8. I’m borderline whether I need an anabolic and the only reason I’m doing it is because I downhill ski, as well as cross-country and backcountry skiing. I can’t afford to lose in my hips. My endocrinologist warned I may lose in my forearm, but she didn’t say anything about losing in my hips. Now I’m wondering if I should not start it and just go on a Actonel, Reclast or Prolia …. Or do nothing! This is all scaring me silly.

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windyshores | @windyshores | Apr 1 7:01pm

All I know personally is that Forteo was way too potent for me and I could tolerate Tymlos, though as you know I worked up to it 🙂

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1 reply
windyshores | @windyshores | Apr 1 8:52pm
In reply to @windyshores "I just wanted to boost my femur neck and also "treat to target," meaning get all..." + (show)
@windyshores

I just wanted to boost my femur neck and also "treat to target," meaning get all the scores as close to osteopenia as possible. I attended a masterclass offered by Lani Simpson, back in 2021, where a woman described her gains on Tymlos and her gains on Evenity after Tymlos. I didn't even realize that was not a protocol prescribed by my endos until I requested it. For now, in both practices I go to, I am the only patient doing this. My idea was to do just 3-4 months for a boost, then Reclast. I have since seen studies investigating that kind of use of Evenity, and hope it becomes mainstream in the future. For now, I am my own guinea pig- and my doctors'!

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Today I read that femur neck only progresses 2.8% in the first 6 months and 7.5% if Evenity is done for the full 12 months. Surely this is from anti-resorptive action but the gain is much stronger than with Reclast (though values are extremely varied for Reclast among studies). So the idea of a boost over 3-4 months may mainly apply to the spine. Nevertheless studies are being done on Evenity for 6 months and Reclast for 6 months vs Evenity for 12 (followed by 12 months Reclast).

I saw 1) 6 months Evenity, 12 months Reclast, 6 months Evenity. 2) 6 months of each 3) 6 months Evenity, 12 months Reclast, 4) 12 months of each and 5) 6 months Evenity, 18 months on Reclast

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1 reply
lynn59 | @lynn59 | Apr 2 6:40am
In reply to @windyshores "Today I read that femur neck only progresses 2.8% in the first 6 months and 7.5%..." + (show)
@windyshores

Today I read that femur neck only progresses 2.8% in the first 6 months and 7.5% if Evenity is done for the full 12 months. Surely this is from anti-resorptive action but the gain is much stronger than with Reclast (though values are extremely varied for Reclast among studies). So the idea of a boost over 3-4 months may mainly apply to the spine. Nevertheless studies are being done on Evenity for 6 months and Reclast for 6 months vs Evenity for 12 (followed by 12 months Reclast).

I saw 1) 6 months Evenity, 12 months Reclast, 6 months Evenity. 2) 6 months of each 3) 6 months Evenity, 12 months Reclast, 4) 12 months of each and 5) 6 months Evenity, 18 months on Reclast

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Interesting .... I'll be keeping my eye on this topic as I'm sure I can benefit from Evenity in the future. I will personally feel more comfortable when it has been on the market for five years or more:)

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mayblin | @mayblin | Apr 2 7:41am
In reply to @awfultruth "@mayblin You might want to check this one out. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190496/ "The Effect of Teriparatide on the..." + (show)
@awfultruth

@mayblin You might want to check this one out.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8190496/ "The Effect of Teriparatide on the Hip: A Literature Review"
This paper which is mainly summarizing the effects of Forteo on those who have not previously been treated with anti-resorptives is quite positive for Forteo and it's effects on the hips. It has an understandable section covering how one could lose cortical bone in the hip and still become more fracture resistant. Perhaps the negative comments about Forteo and the hips are mainly from studies where an anti-resorptive is followed by Forteo, which seems to cause significant hip bone loss? I intend to read more on this but I've no time for that right now. Hopefully this paper and others like it will help us understand this issue better.

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@awfultruth thank you so much for your link! A great comprehensive review and explanation of increased porosity, cortical thickness, and outer diameters of cortical bone resulted from Teriparatide treatment. The increase porosity that concern some of us doesn’t appear to be correlated with bone strength reduction. Rather, it is accompanied by apposition of new bone at peristeal site etc. As @gently pointed out, coupled bone remodeling is crucial for healthier and stronger bones. The porosity increase may just provide more grounds for the coupled process. Bone strength is multi factorial based. Anatomical and mechanical properties play important role, other than bmd. This paper explained how the outer diameters’ increase actually plays a role in resistance to fracture.

Thank you @awfultruth and @gently! I leant a lot from your perspective and help.

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06111945cc | @06111945cc | Apr 2 8:03am
In reply to @sallyj2 "Why do you consider Forteo to be safer than Tymlos and what do you like after..." + (show)
@sallyj2

Why do you consider Forteo to be safer than Tymlos and what do you like after Forteo? Are we all destined to eventually have risks from busphisphrnates? Hrt supposedly may also holds after Forteo or Tymlos.

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Is HRT suitable for a 78 year old?

CC

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06111945cc | @06111945cc | Apr 2 8:07am
In reply to @windyshores "All I know personally is that Forteo was way too potent for me and I could..." + (show)
@windyshores

All I know personally is that Forteo was way too potent for me and I could tolerate Tymlos, though as you know I worked up to it 🙂

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Windy

Please tell me the procedure for gradually taking Tymlos.

CC

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1 reply
windyshores | @windyshores | Apr 2 10:44am
In reply to @06111945cc "Windy Please tell me the procedure for gradually taking Tymlos. CC" + (show)
@06111945cc

Windy

Please tell me the procedure for gradually taking Tymlos.

CC

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@06111945cc The Tymos pen as 8 clicks for a full dose. You can feel the clicks. You can start at a full dose and if you have any issues, go back to 2 or 4, whatever you can tolerate. Once your body adjusts, move up. You want to aim for 6 or 7 clicks at least out of 8. Talk to your doctor about this of course. If you refrigerate it, the Tymlos pen can last longer so the reduced dose doesn't mean you have to throw it out at 30 days. I checked this with the company.

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1 reply
06111945cc | @06111945cc | Apr 2 11:08am
In reply to @windyshores "@06111945cc The Tymos pen as 8 clicks for a full dose. You can feel the clicks...." + (show)
@windyshores

@06111945cc The Tymos pen as 8 clicks for a full dose. You can feel the clicks. You can start at a full dose and if you have any issues, go back to 2 or 4, whatever you can tolerate. Once your body adjusts, move up. You want to aim for 6 or 7 clicks at least out of 8. Talk to your doctor about this of course. If you refrigerate it, the Tymlos pen can last longer so the reduced dose doesn't mean you have to throw it out at 30 days. I checked this with the company.

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Thank you.
CC

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gently | @gently | Apr 2 4:58pm
In reply to @lynn59 "@gently. My endocrinologist said the Forteo dose is not too high for me (I’m 5’2” and..." + (show)
@lynn59

@gently. My endocrinologist said the Forteo dose is not too high for me (I’m 5’2” and weigh 120 lbs). She said they give it to children. I’m about to start, so it will be interesting to see how my body reacts.

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Not so sure about the children. It isn't recommeded for children whose bones are still growing. It is given to kids with hypocalcemia. But the dosage is titrated by weight. And given more frequently by infusion.

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1 reply
lynn59 | @lynn59 | Apr 2 6:15pm
In reply to @gently "Not so sure about the children. It isn't recommeded for children whose bones are still growing...." + (show)
@gently

Not so sure about the children. It isn't recommeded for children whose bones are still growing. It is given to kids with hypocalcemia. But the dosage is titrated by weight. And given more frequently by infusion.

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Maybe you are right? I didn’t challenge her when she answered my question that way. Look her up. She has done lots of research on osteoporosis and hyperparathyroid. Her name is Dr. Aliyah Khan in Oakville, Ontario, Canada. Having said that, she is the endocrinologist who gave me the prescription and said “come see me in two years, your family doctor can look after you in the meantime”. Her listed scholarly achievements are impressive, which is why I chose her. But unfortunately she is spread too thin to answer all my questions or closely follow me. I’m waiting for her to answer an email with a list of questions!

https://experts.mcmaster.ca/display/aliya
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