Fracture while on Forteo

I would not want to wait two years before getting another DEXA. That's crazy. But... four months isn't that long. My doctor likes to do blood tests at six months and nine months to see if meds are having an effect. Then, a DEXA at 12 months.

Hi @paulita i am so sorry to hear this happened to you. You might want to ask for bone turnover markers (P1NP and CTX) to be tested to see how well Forteo is doing. At 4mo of Forteo treatment it is a good time to do the lab. Like njx58 suggested, 4 months' forteo isn't long enough yet for significant bone building on a PTH analog such as Forteo, although it is an important drug used clinically for fracture treatment. Studies showing Forteo's significant fracture reduction were from more than 6mo of treatment when compared to 0-6mo treatment.

While on PTH/PTHrp analog such as forteo/tymlos, checking bone markers early during therapy is a good way to see how well therapy is progressing. A yearly dxa to confirm results is pretty common practice.

A combination of bisphosphonate with forteo will only dampen Forteo's effect as many studies showed. On the other hand, you might want to discuss with your endo the feasibility of adding estrogen transdermal patches or oral raloxifene to Forteo to enhance its effect.

There are limited knowledge of evenity in fracture healing - one study showed it had no effect on hip fracture healing. I didnt read enough yet to know its effect on fracture healing of other skeletal sites. Evenity has an entire different mechanism of action comparing with anabolics like forteo/tymlos. Definitely discuss with your team of doctors.

My osteoporosis presented mainly at lumbar spine. However, I was surprised (probably shouldnt have been) to hear a radiologist's comment of "pan-osteopenia of both feet" on xray of my feet (I have a non-op related foot problem). Since then I have avoided high impact activities such as jumping or running and always wear supportive shoes.

Hope you get to see your endo soon and find a sensible solution going forward.

I broke my second metatarsal in my left foot while on 20mcg Tymlos. The bones in the foot are mostly cortical, while the anabolic help mostly trabecular bones. In fact, studies have shown that Forteo can lead to cortical porosity. I increased my Tymlos to 40 mcg after the fracture. It took 4 plus months for my foot to heal and I still have 2 swollen toes. Six months after my fracture, my P1NP was 310 and my CTX was 1414. Studies have also shown that bone markers may be high six months after a fracture. My endo wants me to take Evista with my Tymlos. I haven't dared do that yet.

While both estrogen and raloxifene are mild-moderate antiresorptives and could serve as a good add-on in this situation, the known 1-2% risk of venous thrombosis for raloxifene is concerning to older population. On the contrary, transdermal patches of estradiol (bioequivalent) does not share that particular concern. Furthermore, estrogen, with its many regulatory effects on bone health, is known to help with all skeletal sites! An individualized assessment for cvd risk and breast cancer risk is needed for hrt usage for sure.

@drsuefowler your ctx of 1414 after 6mo of fracture is unusual. What's your baseline ctx?

My CTX was 519 the first time I had it measured. That was after being on only 20mcg of Tymlos for about a month. That's all I have to use as a baseline. I wanted Estrogen, but my endocrinologist was against it. He thinks that at 74, I am too old for Estrogen. Interesting that transdermal patches of Estradiol are safer than Raloxifene for getting blood clots. I know I would feel better on Estogen than on Raloxifene. Thanks for your response @mayblin.

I saw my rheumatologist yesterday and he thinks that the stress fracture is not related to teriparatide. He wasn't concerned about it at all. He is viewing my high ALP trends as a sign that Forteo is working for me. He says that there is no great proof that Estrogen patches help with the effect of bone building medication. He also won't do bone turnover markers for another year. He seemed very happy and I am reassured. We talked about my going on Zoledronate acid when the 2 year treatment finishes. 16 months to go now !