Great interview with Dr Keith McCormick, very helpful

@255anny I have talked to McCormick for years and he has never suggested supplements, (beyond adding Mk-7), exercise, approaches to immune and gut health etc. for me. Once there are fractures, he doesn't even suggest TBS (interesting that at -3.3 with a history of fractures, he has never done a TBS). It really has been all about medications for me. In a way, that makes things simple. This interview makes things very complicated- perhaps rightly so- but at the moment I just know I lost bone at menopause and with cancer treatment and I need meds.

I have wondered whether McCormick being male makes things more stable. What happens to male hormones at age 50 or so and what effect does any change have on bones. We women lose estrogen and that seems to be a major factor - and our longer lives!. (I cannot do HRT due to hormonal breast cancer, as a side note.)

His -3.3 is interesting. I thought that McCormick recommended meds for a DEXA of -3.3 or below so perhaps he considers himself borderline. For me, as a female, I would try to "treat to target" and get that DEXA up as much as possible with meds before focusing on stabilizing. Stabilizing at -3.3 with a history of fractures seems risky to me (especially doing Triathalons) but he must know what he is doing.

I will certainly focus on holistic approaches once I have a drug holiday or even stop meds- if that ever happens. I do what I can alongside meds but meds are the main menu.

Good points. I think for me I lost a lot bone density after menopause. I was on HRT for 5 years and then stopped when the whole cancer scare thing blew up. At the time, I was seeing 2 Dr's - one for the HRT in Bio form and my regular Gyn. The GYN said oh you need to take the HRT for life. The HRT specialist firmly stated only take it for 5 yrs. max. It scared me! During the time on it, I had an unexplained Squamous cancer on my scalp, Dr's were quite perplexed regarding the origin. That was enough for me to stop the HRT! Back to your point about McCormick and his DEXA score, I too raised an eyebrow about that. Maybe he's a tough guy and thinks he can do it all and obviously his bone density does not scare him. He also mentioned that with very low scores, he would go straight to Prolia. I'm still trying to make the decision of what's next after my Evenity. Finishing in 2 weeks. Meeting with my Dr again to discuss this coming week. Fingers crossed 🙂

It is a constant maze of conflicting information. My docs don't do bone markers and don't go near Prolia unless absolutely necessary due to intolerance of other drugs. They are "world class" doctors and researchers. I also talk to McCormick. Put it all in a blender and what do you have? A confusion smoothie!

I do think McCormick's fairly new advice to try Prolia for one year makes sense though we don't yet know if everyone's rebound will be sufficiently addressed even with that short of a time on it.

For my mental health I am sticking with my main endo. I am grateful he deals respectfully (and somewhat wryly) with questions I bring (whether from McCormick or this forum or research) and is flexible with my sensitivities. But I trust he has good reasons for not doing bone markers (He says they don't tell enough about what is going on, and are affected by other things going on in the body). He jokes that he will prescribe Prolia when he is retiring so he doesn't have to deal with rebound.

A confusion smoothie - perfect! I am not aware of McCormick's advice to take Prolia for one year. Lord knows I searched for that info for days upon days. The rebound is the unknown for sure and it's why I'm hesitant to use it. Are you aware of what he suggests to follow up the Prolia with? I'm curious about that. Your Endo sounds great! My old Endo said the same thing about bone markers and would not use them.

Reclast is preferable after that one year of Prolia, according to McCormick. I have no idea whether this idea has been tested or even used a lot. It may be speculative. If I talk to McCormick I will ask him or maybe someone else can.

My doctors would always want Reclast after Prolia. MCCormick's book "Great Bones" go into a lot of detail about how to safely transition from Prolia to Reclast, using bone markers.

Life with osteoporosis is serious enough so I appreciate an MD with a sense of humor!

My doc says an entire conference could be held to discuss pros and cons of bone markers!

Thank you so much for sharing this information. I was wondering why I was not being tested for bone markers. As I mentioned before, I started my third year on Forteo in July. I hope that this is the right thing to be doing, but I was scared of Reclast from reading about all of the side effects. After Forteo I will take Fosomax and Calcitonin. How are you doing Windy?

Hi @janflute. I am doing my next Reclast in two days and will let everyone know.

Tymlos stopped working for me before 18 months. I hope your doc will make sure it is working or at least maintaining in the third year.

I did Evenity after Tymlos but only for 4 months.

If the Forteo is not working according to testing, can you just go right to Fosamax?

Thank you. I do not know what testing to ask for .Yes,I could go right to Fosomax. I was on Fosomax from 2003-2008 and had no problems.

@janflute if you did Fosamax for 5 years that is already up to the limit for treatment but I don't know if that is a lifetime limit. Your doctor would know. Reclast and Fosamax are both bisphosphonates so same suggested duration for both.

Hi Windy. This posting raised a question for me in light of your endo not doing bone markers. How was it determined that Tymlos stopped working after 18 mos?

I think I recall you saying previously you stopped Evenity because its bone-building mechanism is available only in the 1st 6 months of treatment but why not continue Evenity for 2 more months?