Improve bone density and strength without medication?

Thank you and Happy New Year! I am small too, so I understand taking a little less. I even have a hard time consuming the recommended 1200 milligrams of calcium and don't understand why height/weight is not taken into consideration when recommending how much calcium one should consume.

@susanfalcon52
Was Evenity your first drug?

My husband was just recently diagnosed with osteoporosis. Lumbar T-score -3.4. His rheumatologist wants to put him on Fosamax. We’re concerned about side effects. I asked her about Evenity and she said she’s not heard of it and that for her patients with osteoporosis from high dose prednisone she prescribes Fosamax for 5 years and then possibly another 5.

@isabelle7 can he get a second opinion from a good endocrinologist? It's concerning that this rheumatologist has never heard of Evenity, and 10 years of Fosamax is not recommended by my docs. Also -3.4 would seem to need a bone builder like Evenity, Tymlos, Forteo before Fosamax. What I am seeing if I look up treatment for steroid induced osteoporosis is that the older articles still online mention bisphosphonates like Fosamax as "first line" but in the context of taking them within the first 3 months of steroid use. Any articles that are more current suggest an anabolic bone builder (Forteo and Tymlos) if risk is already present. Evenity is new (2019) but should be considered too. It sounds like his rheumatologist is, well, old-fashioned and not up to date.

Here is a quote from an article on studies of treatment for osteoporosis from steroids, which mentions that bisphosphhonates like Fosamax could be helpful if prescribed within 90 days of steroid treatment. For your husband, with a -3.4, that ship has already sailed.

For an anabolic, this mentions teriparatide (Forteo) but would apply to Tymlos as well, which is similar. Evenity is a possible too but not mentioned here because the article may predate Evenity's more common use. Here is the quote:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4613168/
"GIOP (glucosteroid induced osteoporosis) is a condition where the principal cause of bone loss is reduction in bone formation. This is the rationale for using teriparatide, a parathyroid hormone peptide producing anabolic skeletal effects by stimulation of bone formation. In a 18-month randomised trial conducted in patients with GIOP, teriparatide 20 µg daily was compared to alendronate 10 mg daily; as expected, the increase in BMD was higher with the anabolic agent as compared to the antiresorptive one (7.2% vs 3.4% at the lumbar spine). More importantly, a significantly lower number of vertebral fractures was observed: 0.6% and 6.1% in the teriparatide and alendronate groups, respectively.76 77 Data were confirmed over 36 months."

Here is another one:
https://pubmed.ncbi.nlm.nih.gov/37845798/ (2022 upsdate)

" For adults at medium, high, or very high fracture risk, we strongly recommend pharmacologic treatment. Choice of oral or intravenous bisphosphonates, denosumab, or parathyroid hormone analogs should be made by shared decision-making. Anabolic agents (Forteo, Tymlos, Evenity are anabolics) are conditionally recommended as initial therapy for those with high and very high fracture risk."

@windyshores
This is very helpful information and something I was wondering about. We're so new to this and there is so much info out there that it can become overwhelming. Your help like this is priceless and very appreciated.

I mentioned yesterday that we might want to consider an endocronologist. I'm so glad you mentioned getting a second opinion. I was very disappointed when his rheumatologist said she'd never heard of Evenity. I'm new to this and I already knew about it. Otherwise, she's the chief of rheumatology (which makes me think she should have known??) and she's been great with his giant cell arteritis treatment. However, I don't think she's very knowledgable when it comes to osteoporosis. I'm also glad you mentioned 10 years is too long, which was my understanding from things I've read.

I found a really informational website today that's from the UK. Here's a link in case you want to check it out. https://patient.info/bones-joints-muscles/osteoporosis-leaflet/bisphosphonates

What I like about it is there are links to many different topics to do with osteoporosis and meds, exercise etc.

I'll send an email to our GP today asking for a referral to an endocronologist. That will be a start.

Also, I read a person starting a bisophonate like Fosamax should see a dentist first. That was never mentioned. Have you heard this? I scheduled an appointment for an exam and xrays in mid-June. He's not seen a dentist since 2007, against my wishes. He just refuses to go. Hopefully this will get him in there. Back in 2007 he needed about $3500 worth of dental work done which he refused to have done. He's in no pain and takes really good care of his teeth. But there are obviously issues.

From what I've read it seems like Evenity would be a good starting drug. Would you agree? And you are right that that ship has sailed! Why didn't they recommend taking a preventative bone medication when giving him such high doses of prednisone. I read today that a person taking 7.5 mg of prednisone for 6 months or more can develop osteoporosis. He began in May 2023 at 30 mg for PMR and worked down to 12.5 mg in Feb 2024. He then developed GCA (giant cell arteritis) and things went completely haywire. He had to have three infusions of 1200 mg steroids followed by 80 mg prednisone per day for about a month. We've been tapering every two weeks and are now down to 30 mg per day. So poor guy needs help!!

I really appreciate your comments. It's super helpful when you're new to something as confusing as osteoporosis. The other illnesses, PMR and GCA, though horrible at least have a treatment plan that's understandable. Not so much with this so thank you again!!!

I'm going to print out your comment to share with my husband and with the new doctor once we get one. I'm also going to mention this to our GP when we see him virtually in June. He's been great with us in the past and he might prescribe meds for us if I can give him good solid research.

I have severe arthritis. I started Pilates a year ago. I am flexible now and stable and my bones are strong. I am 58. Best thing I have ever done.

Was your back surgery due to compression fractures?

Hormone therapy definitely helps build bone mass, provides better sleep, better memory and more energy. I am 71 and have been on subcutaneous pelletts 12.5 estrogen and 75mg testosterone for last 20 years. I had a complete hysterectomy 20 years ago so didn't need progesterone. I recently had DCIS with lumpectomy stage 0 grade 2 so can't take estrogen patch or pellets as cells they found were estrogen positive. I just got back on testosterone slow release subcutaneous pellet 50 mg which is the lowest dose. Testosterone definitely helps to build bone and I have read some research articles that show this and it also helps the heart. Taking an estrogen cream vaginally is not absorbed systemically into the body so I plan on asking my doctor for that as well. I have osteoporosis and osteopenia and my numbers are pretty bad. I tried Fosamax over 20 years ago and it caused extreme muscle aches and pains and my numbers did not improve. I already have muscle aches since I have Osteoathritis and fibromyalgia and it just made all those symptoms worse. I am very hesitant to take any meds and have not been good about staying on calcium and doing bone building exercise but I have decided to make it part of my regular routine. Glad there is a platform like this to share info.

@pduff does the testosterone you take convert to estrogen? Also, the amount of estrogen (or progesterone) that feeds our cancers is minute, just from the adrenal glands (or maybe a little from fat) so I would be nervous about the estrogen cream. I have heard other women with cancer do that though. Maybe I am fortunate in not having a partner!

Do you think your hormone treatments were responsible for your cancer?

Grind it up and put it in a small smoothie.

You're doing all the right things. Hang in there!