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What to try and for how long after an Extended Drug Holiday
At 78 I've been diagnosed with Osteopenia officially since 2005, year of my first bone density scan. PCP put me on Fosamax in 1999 and I stopped in 2006 as I'd read that there were limits to how long one should be on such drugs. Fast forward 16+ years to a new PCP and endocrinologist and I was back on Fosamax in 2022. Wonderful endocrinologist left town, new one favored Reclast. Had Reclast infusion this past December and neither she or the infusion center mentioned anything about being well hydrated for the infusion or taking some Tylenol before hand. Obviously we were not a marriage made in heaven. On to endocrinologist #3 who on our first meeting was VERY thorough and I really like her. She is an advocate for Prolia and asked me to read up on it. I would like to put Prolia off since I can see continuing the injections into my 90s could be problematic were I to stop during my more vulnerable years. So FINALLY my question: after my long drug holiday is it possible to go back on Fosamax or Reclast for another 5 years. Spine numbers aren't too bad but I have scoliosis and have read that density numbers are probably too optimistic. I'm active and while I've taken some interesting falls they were all my fault and involved ladders or skis. Any insights would be very welcome before my next meeting with the endocrinologist. I'm scheduled for a scan in November and have had them each year since 2021.
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@cat203 I would not be able to do either safely. For one thing, danger of falling. Pickleball has an impact that would go to my spine and neck and both might involve reaching.
@awfultruth, I was wondering if you would please share more about the hips being a big factor when choosing meds. It seems like it's a challenging area to specifically target and, of course, that's where I have OP. I don't want to hijack the thread so feel free to message me privately if you prefer. Thanks.
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1 Reaction@babs10 @awfultruth can answer but just wanted to interject that although the parathyroid analogs are not supposed to be great for hips, better for spine, I had a 9% gain in total hip score on Tymlos. I was told Evenity might be better for hips....
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3 Reactions@babs10 @windyshores I thought there might be an easy answer but if so finding it has eluded me. I know I have seen stated a number of times that Evenity is better for the hips than Forteo and Tymlos. And I remember a statement by Ben Leder MD maybe in an Osteoboston interview that he would be hesitant to prescribe Forteo to someone with a t-score less than -2.8 (I'm just guessing at the number here but something to that effect). The idea was that Forteo could diminish hip density at least initially I believe? OTH I found a Korean paper that held that Forteo was strengthening to the hip even if density decreased. "Even though TPTD increases the cortical bone porosity of the proximal femur, the bone strength does not decrease as the majority of the porosity is located at the endocortex; further, it increases the outer diameter and thickens the cortical bone."
And what about Prolia and the bio-phosphonates and their effect on hip density and fractures? I think there is a general consensus that the anabolics beat the bio-phosphonates in improving bone density and decreasing fracture risk overall. I saw the same conclusion about Prolia in one or two papers. I think that overall view extends to the hip, but to really answer your question would take a lot more effort.
And then there's individual differences like Windyshores who got great hip gains with Tymlos.
Myself I'm taking Evenity and hoping for the best as I need help in all bone areas.
It would be great to pose the question to an expert panel.
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