Confused by doctor options to choose, including Keith McCormick
I’m still learning and navigating my Osteoporosis diagnosis and trying to get my healthcare providers lined up. I’m 51.
I have a PCP who I will only be using as a “sick doctor” going forward. She is aware of my diagnosis and is not up to date on care or treatment.
I have a neuro-kinetic therapist who I work with (recovering from a back injury) who is extremely knowledgeable in osteoporosis exercise. So I will continue to work with her for strength building.
I have a gyn who is not knowledgeable about osteoporosis and referred me to a local endocrinologist.
Those are all of my current health care providers.
Here’s where I’m getting confused….
I really am drawn to Keith McCormick. I prefer functional medicine but like that he also is incredibly knowledgeable about meds and doesn’t hesitate to use them when needed. I have no problems with video appointments.
I have a consultation with the Mayo Clinic in July - the endocrinology team.
They will review my case and decide if they will provide a treatment plan for my local docs or if they will accept me as a patient. So that’s up in the air.
There is a local functional doctor, who specializes in healthy aging and osteoporosis that I am considering.
The endocrinologist that my gyn referred me to doesn’t have an opening until August.
My questions….
Do people use Keith McCormick to completely manage osteo? Or do you also have a local endocrinologist and they work together? Furthermore, when McCormick orders labs, is that done at a local lab or through my regular doc? Thinking costs…..and insurance (I have Cigna - too young for Medicare) for all of those lab tests.
Does anyone have a functional doctor that manages osteoporosis in collaboration with Keith McCormick?
Does anyone see a dietician? I eat a whole foods plant based diet, so am realizing that I am deficient in quite a bit of protein and calcium according to “Strong Bones” teachings. Both of the functional med doctors have nutritionists on board that could help with that.
I’m so overwhelmed just choosing providers! What do you suggest?
Cost does matter - it isn’t the driving factor at this point (understanding and knowledge is the highest priority now).
As of now - I’m flying solo until the end of July, when I meet with Mayo. Wish I had some solid medical guidance before then, but so far have not been able to get earlier new patient appts.
What are most people doing - especially those who have seen or talked to Keith McCormick for a consult or care?
The more I read, the more confused I get. I have time to make decisions, but half a year will have passed before I actually see someone, let alone make any decisions about care. Need to get my ducks in a row.
Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.
bluebonnet, most patients are taking bisphosphonates after Forteo or Tymlos. Even before the black box was lifted, my prescribing endocrinologist knew about the Wister rat and the flaw in the studies. Now, some patients are extending Forteo use without a bisphosphonate in between.
My suspicion is that the idea of "sealing the gains" is a hang-over from the days where there were no anabolics. Now, the understanding is that sealing the gains prevents the important process of remodeling. Look at this though from 2005
The amino-bisphosphonates strongly inhibit osteoclastic bone resorption. During normal bone remodeling, osteoblastic bone formation follows resorption and occurs within the eroded cavities, so inhibition of bone resorption also results in inhibition of bone formation. Bone biopsy studies using double tetracycline labels show that the bone-forming surface is suppressed by 60–90% with usual doses of the bisphosphonates (4, 5). These drugs are certainly not anabolic! The volume of bone does not increase. The bone density as measured by dual-energy x-ray absorptiometry, however, does increase. This is because the bone is no longer remodeling, and so there is not much new bone. The older bone is denser than the newer bone; there is less water and more mineral in the bone, and the radiographic techniques thus measure the higher density.
https://academic.oup.com/jcem/article/90/3/1897/2837115
The article clarifies that there is no known way to remove bisphosphonates from bone and it can persist in preventing remodeling for ten years. Which is why the effect of Forteo is blunted when taken after a bisphosphonate.
Does staying on Forteo longer than 2 years maintain the bone that was previously built? If we need to build more bone how does this work? I still need to read the article you attached.
@bluebonnet242,
the article may not even interest you. It's just some speculation about bisphosphonates.
Clinical trials on Fotteo were limited to 24 months. I don't know of any trials ensuing after the cancer warning was removed. Physicians are left to determine which patients would benefit from extended use.
Ten year follow-up of women who stopped Forteo after 18 month indicates a sustained fracture protection while BMD returned to baseline gradually over those ten years. Though those women took either HRT or alendronate.
After taking Forteo the cells that build bone proliferate. Their activity stimulates the cells that break bone down. Eventually the osteoclasts can dominate in number though there isn't evidence of disadvantage in this.
The assumption comes from a time before Forteo when the only pharmaceutical control was to reduce osteoclasts.
But we can use bone markers to determine the relation between osteoclasts and osteoblasts on an individual basis in our own treatment.
So far it appears as though continued use of Forteo doesn't just maintain gains but advances them.
Now that there is generic Forteo, the cost for this is much less. Do you know if generics (bio similar?) are as effective?
@gently my bone marker tests showed that Tymlos stopped working before 18 months. At this point I don't think my doctors would recommend continuous use for more than 2 years for that reason.
@windyshores, this is so interesting. Thanks. I'd be curious about the numbers and if you repeated the tests. One problem with CTX is that it is easy to mishandle. It has to be refridgerated but can only be refridgerated for a short period then it has to be frozen and remixed before being examined.
You know all the rest: time of day, quality of sleep, food intake
Was it the CTX was too high or P1NP too low. I'm excited ( you can see) about this piece of information.
When I stopped Forteo for a month the CTX dropped appreciably. I should have retested after resuming for a month. But I think the month was too long. I'll try for two weeks and then three weeks in the coming year and be more organized with the bone markers. Was your md orchestrating; mine won't be.
babbs, not to interrupt, but my prescribing physician told me that they are exactly the same in effect. I used them interchangeably my first year.
The physician could be misinformed.
Even more interesting that it was Tymlos. Tymlos is thought to raise CTX as much as Forteo, but maybe it was P1NP that had declined.
@gently the surprise was that me P1NP was low. My CTX was too. But at that point I had excellent gains. I was told by two doctors and McCormick that the effect had waned as it usually does at some point. I stayed on Tymlos another 6 months to complete the 2 years and was told I was probably safe to do that, but I also wanted to really explore the next steps, which ended up being Evenity before Reclast. My P1NP was low with Evenity too. Timing of testing has never been ideal for me. My doctor doesn't do bone marker testing so I have to arrange myself.
ps I thought it was pretty well-known that these drugs peter out over a year or year and a half...the question now, as you well know, is if and when we can again get a boost from them, especially after bisphosphonates short term
@gently @windyshores - I am sooo curious to hear what you all continue to discover in this line of thinking. As I just started Forteo , but obviously already looking ahead!!!!