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Which medication to choose
I am a 73 years old female. I have been getting my dexa scans every two years sometimes every year since I was 55 years old. I have always been active gardening, swimming, palates, yoga, hiking ….. I have never broken or fractured any bones.
A year ago my primary Dr. advised me taking Boniva. I did not rush into starting but tried to do my research on the different kinds of medications to help slow down bone loss and try to increase my bone density.
It’s been a year since then and I went to see an Endocrinologist in February of 24.
My t-scores pointed to osteoporosis in the hip area and osteopenia in the lower spine area. They both are on the borderline. I just saw my endocrinologist and she said she would not prescribe Boniva as it doesn’t help all the areas like my hip. So she recommended going on Fosamax weekly. I asked if there was a monthly medication and she said Actonel . After reading so many reviews I am really unsure what to take.
All of the other medications are for people prone to breaks and fractures and high risk I think. What’s your opinion?
Meridith
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hi, meri.
are you then osteoporotic in the hip? If you are -2.5 or less I'd suggest considering Tymlos with bone markers.
Hello,
Currently, it’s my femoral in hip that is -2.1. My spine is improved .
@gently, is Tymlos considered the best medication for the hip? I know it's a hard place to specifically target with meds and exercise. Thanks.
babs10,
I consider Tymlos to build the strongest most resilient bone in the hip.
Evenity will build a more dense bone faster. Evenity causes the deposition of new bone at the outer edge of bone where there hasn't been bone before. If you are looking at bone density alone you'll find in meta studies (studies that try to align results from different clinical trials into a single study) indication that Evenity produces a "calculation" of a lesser fracture risk. With a wider heavier bone, frax calculations will err on the side of greater BMD. I offer this link as a counterweight to my thinking
https://academic.oup.com/jcem/article/104/5/1623/5418882
This bone called modeled bone doesn't repair underlying bone and isn't nuanced by activity. For both of these reasons it isn't as fracture resistant as remodeled bone--Tymlos-bone.
If you are at a comfortable stage in life a little more homebodied not planning to activities that put tension on bone, a person might consider Evenity, with caution regarding adverse effects. Though if the low density in the hip is in the femur head ( as opposed to the shaft) I would also caution that Evenity notably causes inflammation in the joints which increases bone loss and can make it painful to move around, much less exercise.
If you've decided on Tymlos you might want bone markers because Tymlos bone is slower to mineralize. Even while offering fracture protetion the improvement in density is slower to evidence on dxa.
I am seeing more recommendations for Evenity. I see the trend as direct result of amgen advertising directed at our physicians. In these ads the use of Evenity is followed by Prolia, since Amgen gives us both.
@meri8181
Usually women suffer the largest loss of bone in the five years after menopause. So, your numbers look darn good.
With your numbers I would be wanting Forteo since it builds stronger more resilient bone.
It isn't as effective after bisphosphonate, so some endocrinologists are using Forteo first, not just with those who have high fracture risk.
Preserving Forteo and Tymlos for the greater risk patients is an economic feasibility determination with what we know in 2024.
A decision to remain on a bisphosphonate for 3 years makes sense. I'd choose risidronate Actonel over alendronate Fosamax because it stays in the bone for a shorter duration allowing for better results from the relay medication you 'll need in three to five years.
Anyway, you might not want to an injection every day either.
You'll be more likely to have an adverse reaction with the higher monthly dose. I hope not, but you can always switch back to weekly Fosamax.