Confused by doctor options to choose, including Keith McCormick

@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.

@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

I hope we can still get a boost from an anabolic after bisphosphonates. I’m not sure what we do long term. I started Tymlos a month ago at 63. If I’m on that for 18 mos to 2 years and then do a bisphosphonate for a couple of years then hopefully an anabolic again then bisphosphonate again, what comes after that. If there are time limits on each of these drugs how does this work for someone who may need to be on them for 30 years?

@bluebonnet242 exactly. We are basically pioneers.

@gently and @formisc @windyshores
UPDATE: You won't believe this!
As promised, here is my news from today's visit to the endocrinologist; who was to give great wisdom on "what do I do now", considering the serious adverse reactions to Prolia, Osnuvo and Residronate.
The last thing you expect is what happened ... apparently, there is no other drug that I can try.
I was about to hit a new level of despair, and then she said.... "but why are you being treated for Osteoporosis in the first place?"
She reviewed my bone density results over the past several years, and concluded [drum roll please... ] "You don't have Osteoporosis... there is no need to treat"... !?"
I am gob-smacked! Delighted but amazed!
She continued to show me my results with a visual aid, explaining that I do not meet the criteria for Osteoporosis!
How did this happen --- no clue.... of all my concerns, this was never thought about.
I will return to my G.P. to see if we can add any sense to this ridiculous situation, because this must NEVER happen again!
My health balance is already precarious, without such a dreadful error in the works!
My respirologist will be extremely angry as I have now lost some function in my lungs due to the resultant increase in infections from the Prolia. [not to mention the dangerous adverse reaction to Osnuvo]
So, I sign off ... a bit weary, perplexed but so very thankful that this long and difficult journey is now at an end.
Again, I thank all of my Connect Buddies for your on-going support and wisdom during this adventure.
May all of our diagnosis be the correct one!
All the best,
christine

@gently and @formisc @windyshores
UPDATE: You won't believe this!
As promised, here is my news from today's visit to the endocrinologist; who was to give great wisdom on "what do I do now", considering the serious adverse reactions to Prolia, Osnuvo and Residronate.
The last thing you expect is what happened ... apparently, there is no other drug that I can try.
I was about to hit a new level of despair, and then she said.... "but why are you being treated for Osteoporosis in the first place?"
She reviewed my bone density results over the past several years, and concluded [drum roll please... ] "You don't have Osteoporosis... there is no need to treat"... !?"
I am gob-smacked! Delighted but amazed!
She continued to show me my results with a visual aid, explaining that I do not meet the criteria for Osteoporosis!
How did this happen --- no clue.... of all my concerns, this was never thought about.
I will return to my G.P. to see if we can add any sense to this ridiculous situation, because this must NEVER happen again!
My health balance is already precarious, without such a dreadful error in the works!
My respirologist will be extremely angry as I have now lost some function in my lungs due to the resultant increase in infections from the Prolia. [not to mention the dangerous adverse reaction to Osnuvo]
So, I sign off ... a bit weary, perplexed but so very thankful that this long and difficult journey is now at an end.
Again, I thank all of my Connect Buddies for your on-going support and wisdom during this adventure.
May all of our diagnosis be the correct one!
All the best,
christine

@gently and @formisc @windyshores
UPDATE: You won't believe this!
As promised, here is my news from today's visit to the endocrinologist; who was to give great wisdom on "what do I do now", considering the serious adverse reactions to Prolia, Osnuvo and Residronate.
The last thing you expect is what happened ... apparently, there is no other drug that I can try.
I was about to hit a new level of despair, and then she said.... "but why are you being treated for Osteoporosis in the first place?"
She reviewed my bone density results over the past several years, and concluded [drum roll please... ] "You don't have Osteoporosis... there is no need to treat"... !?"
I am gob-smacked! Delighted but amazed!
She continued to show me my results with a visual aid, explaining that I do not meet the criteria for Osteoporosis!
How did this happen --- no clue.... of all my concerns, this was never thought about.
I will return to my G.P. to see if we can add any sense to this ridiculous situation, because this must NEVER happen again!
My health balance is already precarious, without such a dreadful error in the works!
My respirologist will be extremely angry as I have now lost some function in my lungs due to the resultant increase in infections from the Prolia. [not to mention the dangerous adverse reaction to Osnuvo]
So, I sign off ... a bit weary, perplexed but so very thankful that this long and difficult journey is now at an end.
Again, I thank all of my Connect Buddies for your on-going support and wisdom during this adventure.
May all of our diagnosis be the correct one!
All the best,
christine

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.