Risks of Hip Surgery with Osteoporosis

sugarmonkey, are you on an anabolic drug for osteoporosis. You might want to be on one for several months before surgery. Forteo and Tymlos are good choices. You'd possibly save yourself from surgery.

sugarmonkeys,
I have osteoporosis and have been on Evenity for 11 months.
In June 2023, I had a right hip replacement. Before the surgery, I asked the surgeon about my mushy hip bone and the surgery. I had watched a video of a hip replacement surgery - not for the faint hearted. He said that he would use some additional hardware if necessary. As it turned out, that wasn’t necessary. The hip replacement was a big success and has restored my mobility.
I still have osteoporosis, but will not be fracturing that titanium hip.

I wonder if -2.7 presents a problem. That is not severe, but it is osteoporosis. What does your doctor say?

I have pain lying down or sitting, and it is from a bone spur, not a joint issue. The bone spur is extra bony growth that presses on a nerve when I sit or lie down. Have you had imagining done? You seem to know it is the femur neck at issue...

How disabled are you? I am still avoiding surgery for spine and hip but there is an argument to get ahead of it. You could do a bone builder like Forteo, Tymlos or Evenity. The first two also help with healing, so I have no idea what the sequence should be. Hope the ortho and endo can communicate!

I saw an orthopedist who does not do surgery, for an opinion. He does lidocaine shots but they didn't help. They help most people though.

@sugarmonkeys - it’s unclear if you are just thinking a hip replacement is in your future , or if that’s something a physician has said to you. If you have n’t seen anyone , I agree with windyshores , you should make an appt cause you may be stressing about something that’s not even in the cards. I went to see a very good sports medicine physician that works within an orthopedic practice. I wanted to see someone that has tools in his tool chest other than surgery. But keep in mind there are lots of reasons for hip inflexibility and pain. You might even want to first start with a good orthopedic PT , then sports med physician , then orthopedic surgeon if needed as your situation begins to be figured out. Keep in mind there are many reasons and underlying issues that can cause those types of complaints at the hip. It’s a complex joint area. Good luck!!

@ans makes a great suggestion. I have gotten more diagnostic info and pain relief from a really good PT, who does massage (manual therapy)and ultrasound.

Orthopedists who don't do surgery are good resources with no investment in what you decide!! Not that surgeons are unethical, just that they lean toward that kind of action.

Thank you all for your comments. I am not disabled, just achy when I stand up from sitting. I've been studying to be an Aquatics Fitness instructor which entails a lot of reading (over 300-page book, 100 pages of typewritten notes & lots of studying). So, I've been sitting way too much. I'm now in the memorization mode so standing while studying which helps.

My Sports Medicine Orthopedist whom I saw a few weeks ago gave these options:
1. Modify activities (avoid high impact).
2. Intra articular steroid injections (1 injection per week for 3 weeks).
3. Surgical intervention.
He did not say I needed surgery. I'm just wanting to understand what the risks are when that time comes.
Physical therapy is a good idea. It may be the arthritis that is bothering me the most. I have it in both hips, as well as other parts of my body. I also remember having an inflamed bursa in my hip back in 2005.

I've had osteopenia since my 40s & was diagnosed with osteoporosis since 2014. Sometimes my Dexa scans show that it's getting better & sometimes it shows it's getting worse. One technician told me that you could have 2 Dexa scans in a row & may get different readings. My Arthritis doctor told me to always get my Dexa scans at the same place because different machines could give different readings. Good to know. I'm due for one a Dexa scan this Fall.

I was on Fosamax for several years & my Arthritis doctor took me off of it because she said that you can only take it for so long because it stays in your system for 10 years. Then, it does the opposite of what it's supposed to do. Therefore in 2015, my Arthritis doctor suggested Reclast infusions. I have had Reclast infusions 3 times over a period of 6 years. The last infusion was last year. My side effect from Reclast is that it's thins my hair which is annoying. Steroids does the same thing. My Arthritis doctor has suggested Evenity but I'm stalling due to the cost & concerns about her suggesting Prolia after the 12 months of Evenity infusions. Currently, I'm not taking anything besides Calcium & Vitamin D.

I'm trying to educate myself on future actions & I notice this forum is very helpful.
Thank you again for your assistance. It is greatly appreciated.

@sugarmonkeys I am a little confused by your post. You have had osteoporosis since 2014, took Fosamax for several years, and did Reclast in 2015. That is only one year after your diagnosis. So did you take Foasamax before you had osteoporosis?

If a doctor said you should stop Fosamax and switch to Reclast, that is very confusing also because they are similar medications- bisphosphonates- except that Reclast is stronger. So you have been on bisphosphonates for 10 years now, which I have read is kind of the limit. Bisphosphonates are anti-resorptive and affect turnover.

Evenity is also anti-resorptive for the last 6 months. There is a study out using Evenity for only 6 months and then "locking in" gains with Reclast or Fosamax (or Prolia). Wonder if your doctor would allow that.

Tymlos and Forteo build quality bone and might be an option- ask you doctor. Previous bisphosphonates can affect their effectiveness (and that of Evenity too, but about 1/3 I read) but one of these drugs (Tymlos) was very helpful to me. Again, you have to "lock in" with Reclast or Fosamax.

Prolia is often suggested as a follow-up but is difficult to get off without rebound, and also has to be followed by Reclast or Fosamax. I figure once I hit 85 I would do Prolia because presumably I would never have to get off!

Doing bisphosphonates for so long leaves you in a tough place but there are some really good medications that you could try and then hopefully only do a dose or two of Reclast at the end of those meds, according to what my doctor is saying to me.

People do get put on Fosamax for osteopenia. It happened to a friend of mine and she ended up with fractures due to being on it too many years,

@normahorn two friends of mine were recently told to take Fosamax with osteopenia in one case, and borderline in the other. I didn't think doctors were doing that anymore but they certainly were before the other meds we now have, were available. I guess they still are. Maybe it is a good thing for borderline cases-?

I don't know what I would do with scores like -2.7 or -2.9. @sugarmonkeys I forgot you were at -2.7.

It is becoming clear that sequencing and duration are issues for all of us. All these meds have limited time we can take them so unless we are very old, not sure what we are going to be doing for treatment in the long run.

@sugarmonkeys I hope you get good answers!

@windyshores sorry for the confusion. I was not clear. I took Fosamax when I was first diagnosed with osteopenia in the early 2000s to around 2013. I will ask my doctor about Tymlos & Forteo. I am not familiar with either of those drugs. Thank you.