What to do!

Posted by guinivere @guinivere, Apr 18 12:04am

My endocrinologist today through her nurse has let me know that my tests are back & she wants me to go on either Fosomax or
Prolia & she wants my decision like tomorrow! I know I have to get going on something as I am 86 with bad bone density numbers - like 3.6, 3.6 & 3.4. What to do!!!!!!!!

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With those numbers at your age I don't think you have much choice, sadly. -2.5 is officially osteoporosis. My doctor told me that older osteoporosis patients sometimes fracture their bones merely by turning over in bed. As to Fosamax v. Prolia all I can say is that Fosamax gave my mother severe jaw problems, so I am biased. Others will be in a better position to comment.

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@freckle1

With those numbers at your age I don't think you have much choice, sadly. -2.5 is officially osteoporosis. My doctor told me that older osteoporosis patients sometimes fracture their bones merely by turning over in bed. As to Fosamax v. Prolia all I can say is that Fosamax gave my mother severe jaw problems, so I am biased. Others will be in a better position to comment.

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Re all the bad possibilities of numbers like mine at my age (86), I am doing pretty well considering. I am single (divorced my ex eons ago) & have run a cat rescue here for almost 20 years. I have 9 in my house, some of whom sleep with me regularly. I have always wanted a magical genie to come do the litter boxes but so far none has appeared
I also have had COPD for a while, maybe 6 years. Osteoporosis is my latest gift & one I would very much like to return!
I have only fallen once, about a year ago,& fractured a bone in my wrist which hurts on occasion & then I wear that bionic looking brace for a while & things are better.
I live in Wisconsin on a little Wisconsin River village where there is a place right next to the river that serves wonderful macaroni & cheese & dark beer. I am going to head out there now!

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@gently

Guinivere, tell your doctor that Fosamax is too slow, Prolia is too dangerous and with your numbers you need an anabolic.
Of course, you don't have to decide today, but your doctor is afraid you might fracture. It's good that the office called you right away and good that she is concerned.
Windyshores gives the best advice and has the most experience. I would cross off Evenity, but it's better than the two you are offered.
You should call them so they can get started in case there is a slow-down with insurance.

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I left a message with the UW doctor explaining why I COULD not take Fosomax (pre-existing bad esophagus condition) & asking her if she would prescribe Tymlos. That was Thursday morning. Left another message to her nurse this morning re that. Have not heard from either of them. And now we are t the weekend.

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Guinevere, after they give you the rush.
I'd thought to suggest you have them expedite your request. Your doctor may have to do some research. After, the office will have to get insurance approval. It can take some time expecially if the insurance doesn't want to approve and they have to appeal. Still, your request should have generated a response. I suspect they were surprised, probably expecting you to resist.
Excellent choice, Tymlos.
I especially like that you left the re message this morning.

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@gently

Guinevere, after they give you the rush.
I'd thought to suggest you have them expedite your request. Your doctor may have to do some research. After, the office will have to get insurance approval. It can take some time expecially if the insurance doesn't want to approve and they have to appeal. Still, your request should have generated a response. I suspect they were surprised, probably expecting you to resist.
Excellent choice, Tymlos.
I especially like that you left the re message this morning.

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@guinivere hope you can do Tymlos!!!!
Your description of where you live makes me want to visit!

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@windyshores

@ppat4pr it is true that anti-resorptives like Fosamax affect bone turnover , and it is turnover that creates new, quality bone. Bone density improves, however, on Fosamax. If Fosamax is used for a short time, the dental and femur fracture side effects are rare. At a certain age, I would even consider Prolia, but it is very hard to get off.

With osteopenia you may be able to try more natural approaches first, especially with the help of your more holistic doctor. But be careful. I am buying a hip pad for icy weather! Do your two doctors communicate? Is it a PCP who is recommending meds or an endocrinologist?

I will say that for my mother, starting at age 88, falls were an issue, so working on balance is a good idea too!

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Thank you so much for your response. My endocrinologist wants me on Fosamax & my GP agrees. I was on it years ago & had some problems with my jaw so am very reluctant to take it again. As I said, I am 84 and rather sedentary. I would appreciate your view. I do not know what bone turnover is.

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@ppat4pr

I have no idea what to do. I am 84 with osteopenia. My physician also wants me to go on Fosamax but I have been told by a very reliable holistic chiropractic doctor that it causes the bones to become brittle so that when they break, they actually shatter!

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Do you have an Osteostrong franchise near you. I don’t take any medication and this program I uses no medication but is a series of weight bearing exercises.
Just go in and talk to them.

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@gently

janflute not everyone has adverse reaction to Reclast. Some people are on bisphosphonates for many years and don't have problems with osteonecrosis or AFF. Your jaw should have recovered by July. If you are going with an implant, you might ask to extend your Forteo use.
Now that there is no limit to the amount of time allowed take Forteo patients are opting for a three year course. My hesitation for three years comes from the bone markers, which seem to become imbalanced between over the second year. We take a bisphosphonate after two years to "seal the gain." But what does that mean. Bisphosphonates do clad areas of the bone for seven to ten years. And they lower the osteoclasts number. So you have bone that is less flexible, doesn't repair cracks and can prevent fracture.
Findings from cadaver bones are that the bisphosphonate remains in the bone until breaks away at the margins of attachement.
It would be better if when we quit Forteo we could do bone scans every month to determine when bone loss ensues after treatement. What we use instead are bone markers at six month intervals. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730878/#:~:text=Context%3A%20In%20postmenopausal%20women%2C%20bone,in%20men%20is%20less%20clear.
It looks to me like stopping Forteo for one month gives you the advantage of dropping CTX without the multiple possible and also the real disadvantages of Reclast.
Forteo helps to integrate the materials used for dental implants and has none of the risk of osteonecrosis or AFF.
My own plan is to do a reset after Forteo by stopping the medication, probably for a month, and then to enjoy the robust second application of the drug.
Alendronate might be an alternative to Reclast. It doesn't adhere to the bone for as long as Reclast. And you wouldn't be risking the severe reaction that some experience.

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@gently I find this very interesting. So you will not be on any medication for a month and will restart Forteo. No bisphosphonate? Is your doctor good with this plan?

The bisphosphonates scare me with the side affects and the fact that you can only be on them for a certain period of time. At 63 I will be starting Tymlos so will be on that for 2 years and then follow up with a bisphosphonate for up to 5 years. Then what?

It would be great to continue with an anabolic after a month break.

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@windyshores

@guinivere hope you can do Tymlos!!!!
Your description of where you live makes me want to visit!

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Gently, it's also the home of Frank Lloyd Wright & his home & estate with Taliesin School of Architecture are right across the river!

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@gently

Guinevere, after they give you the rush.
I'd thought to suggest you have them expedite your request. Your doctor may have to do some research. After, the office will have to get insurance approval. It can take some time expecially if the insurance doesn't want to approve and they have to appeal. Still, your request should have generated a response. I suspect they were surprised, probably expecting you to resist.
Excellent choice, Tymlos.
I especially like that you left the re message this morning.

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Basically I did resist. She wanted me to start with Fosomax & then at some point to Prolia. I am ok with Prolia after something else but it can't be anything that has the gastro/esophageal effects that Fosomax has as I am already on a special (but mild) diet re the state of my esophagus after an examination of same several years ago.

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