Struggling with making an osteoporosis treatment decision

Posted by heyhey @heyhey, Dec 15, 2020

I am just struggling to make a decision about my treatment. I had my first bone density test and found I have osteoporosis. I have a couple of -3.2 vertebrae. My hip bones less problematic. I'm 60, active and fit. I've seen an endocrinologist and a rheumatologist who were both highly recommended. Both said "Evenity" before I barely sat down. But there is so little known about Evenity, and nothing known about its long term effectiveness or risk. I've read heart breaking posts from women who were advised to take Prolia with the same assurance and then had multiple debilitating fractures because so little was known/admitted about rebound risk. I am tearful and anxious and sleepless. I've been so healthy my body has carried me through so much life and adventure. I just don't know what to do , whether I'm putting me/my body at risk. Both doctors are paid consultants for Amgen. I feel hopeless and distressed. One of the doctors, although I said I wanted to consider my options, went ahead and got pre authorization for Evenity from my insurance "to show me how easy it would be". I feel cornered. My general doctor also has concerns about me being put on a relatively unknown drug when I haven't tried something like Forteo with a long track record.

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Profile picture for finch @finch

I am in orlando and looking for osteoporosis specialist, who are you seeing? Have you found a closer place for REMS scan? How about a Functional Medicine Dr.

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Most osteostrong locations have echo light scanning ability. I think it travels from location to location but I know there is an Osteostrong in Orlando. My doctor, after my latest dexa, just called the pharmacy and ordered fosomax for me even though I said I would take no medication. Good luck to you!

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Profile picture for patjack2 @patjack2

Most osteostrong locations have echo light scanning ability. I think it travels from location to location but I know there is an Osteostrong in Orlando. My doctor, after my latest dexa, just called the pharmacy and ordered fosomax for me even though I said I would take no medication. Good luck to you!

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Do you have an endocrinologist or other health professional with solid training in Osteoporosis treatment? Someone who is up to date on the range of approaches, medications and meds sequencing. Might be a solid first step. I think of osteoporosis treatment as the long game. There is lots to learn and it can be confusing. Fosomax is often prescribed first but current thinking on treatment with medication says bone builder first...like tymlos, forteo or evenity. Of course I am not a doctor and dont know your medical history. There is lots of wisdom here.

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Change drs at once. Evenity is also made by AMGEN who make Prolia. How convenient to have another of their drugs available. And these guys are working for AMGEN. Well done finding that out. We all in the same boat and feel depressed that we have been advised to take drugs that hasn't had long term data. I read that some women have had increased bone density with Prolia. What a joke as l believe those new 'bones' are mere camouflage jobs. I read thar it's like renovating a house, where you cover up the problem but it is still poorly maintained underneath. Same with Prolia bones. That's why you are lucky if you can get an Echolight scan that shows you the quality of the bones. Good luck to all of us.

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I feel grateful that these drugs are available to those of us who want to go that route. During my bone journey I've taken fosomax. Forteo, evenity and now Prolia. The "worst" side effect was a bit of gird with fosomax. I didn't want to go the route of my sister in laws mother who was bed ridden and in agony from osteoporosis and no meds available. I recognize that some people have good results from other methods but those were not my path. Good luck to you.

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Profile picture for victor5211 @victor5211

Change drs at once. Evenity is also made by AMGEN who make Prolia. How convenient to have another of their drugs available. And these guys are working for AMGEN. Well done finding that out. We all in the same boat and feel depressed that we have been advised to take drugs that hasn't had long term data. I read that some women have had increased bone density with Prolia. What a joke as l believe those new 'bones' are mere camouflage jobs. I read thar it's like renovating a house, where you cover up the problem but it is still poorly maintained underneath. Same with Prolia bones. That's why you are lucky if you can get an Echolight scan that shows you the quality of the bones. Good luck to all of us.

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These posts make me so glad I did Forteo. 2 years, nothing extra to navigate. Fosamax afterward.

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Profile picture for gravity3 @gravity3

I feel grateful that these drugs are available to those of us who want to go that route. During my bone journey I've taken fosomax. Forteo, evenity and now Prolia. The "worst" side effect was a bit of gird with fosomax. I didn't want to go the route of my sister in laws mother who was bed ridden and in agony from osteoporosis and no meds available. I recognize that some people have good results from other methods but those were not my path. Good luck to you.

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@gravity3 I agree. I don’t want to have the spinal compressions my mother had in her 80s. I’m 70 and recent Reclast has stopped the yearly decline in bone density that I had. I was resistant to take anything - Fosamax was suggested 15 years ago, but when I hit osteoporosis I finally did something. My numbers are back up into osteopenia. I realize that a biphosphonate is not building bone, but I’m not losing more bone and that’s a plus. Only side effect that I felt was a couple of days of flu-like symptoms. These drugs we take are powerful and cause other effects that I cannot not see. But my mom was in constant pain, most she hid. She tried a variety of pain relievers, kyphoplasty, tens unit, trial implanted nerve blocker, and more. None of them worked. We all just try to do our best in balancing what we hope will be the better outcome.

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I'm feeling the same as you. I'm 57 and active an fit. I just recently was diagnosed with osteoporosis my T score was -2.7 in lower lumbar and less in my hip it's -1.25. I had ostopenia in 2022 and was taking alenondrate 35 mg to treat it. Had my 2nd compression fracture 2 weeks ago and just had another deciding-scan in 2025 my ostopenia turned into osteoporosis. I see a rheumatologist on 11/12 and I'm struggling on what do do? My pcp upped my dosage to 70 mg of alenondtate until I meet with my rheumatologist. I'm scared but I know o have to do something for treatment but I'm having a difficult time deciding... I'm going to have to wait to see what her plan is.. I'm in Chicago.

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Profile picture for Teri @tsc

I think you are right to be concerned and shouldn't let yourself be backed into a corner. I am 70, just diagnosed with osteoporosis, with a T-score of -3.1. It was kind of shocking because I've walked at least 5 hours a week for the last 25 years, done strength training on a regular basis, until the last year when I got really sick (but managed to keep walking through it). I also was just diagnosed with an autoimmune disorder that requires me to be on prednisone, a bone thinning drug. It will be long term. I have a rheumatologist I trust and a close friend who is an excellent doctor. The rheumatologist prescribed Alendronate and my friend supported that. It has been around for years. My mom took it (as Fosamax). She had bad osteoporosis - with the dowager's hump. She did not get additional fractures. My aunt, who took no drugs, died from spinal fractures. The Alendronate is a once a week dose. I'm going to try to build my bones back better so keep walking and do targeted exercises for the osteoporosis and try to get off the drug. They know enough about it now, that after 5 years on it, a drug holiday is taken. Carol Michaels is a PT and an expert on Osteoporosis. She has videos on You Tube - safe strength and stretching exercises for osteoporosis - with no forward flexion of the spine. By the way, I am not a paid consultant for Alendronate! Wishing you the best.

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@tsc Teri are you taking 70 mg once a week of alenondrate? Is it building new bone?? How have your T-scores been since using it?currently I'm on that until I see my rheumatologist on 11/12.. I'm 57 my last T-score was -2.7 in September..

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Profile picture for Catcando @catharbert

To everyone who is apprehensive about taking drugs for osteoporosis I want to say try Evenity especially if your osteoporosis is severe. Somehow I managed to ignore several years of Dexascan results telling me that I had osteoporosis so when I finally paid attention it was already severe. My endocrinologist recommended Evemity, one of several new drugs that can rebuild bone. I was pleasantly surprised when I got a new Dexa after only a few months that showed considerable improvement in my spine. However I lost more bone in my hip joint which I attribute to the fact that I was not exercising. I think that it really is important to exercise along with taking supplemental calcium and Vitamin D3, getting enough protein and eating a healthy diet overall. I have other health problems and pain meds I take for those makes it difficult to keep exercising, but I am trying harder now.

I want to urge those who are hesitant to take the new osteoporosis drugs to take it from me they are safe and nothing else will help you rebuild your bones like Evenity. I was cautious at first and instead of taking a drug I thought I could eat a lot of yogurt and drink more milk and eat veggies that have calcium in them. Using those foods to fight this disease is fine if you have osteopenia or earlier osteoporosis but if your condition is severe like mine you should be looking for something to give you a quick start. I usually have a negative reaction to drugs but I did not have any real problems with Evenity and it is only a once a month injection in the doctor's office. After 12 months you have to switch to something else. My doctor recommended Prolia. I finished Evenity in June and I've had 1 Prolia injection which was fine. Prolia is injected only twice a year and is said to help maintain the gains you make with Evenity and even build more bone.

You don't want to mess around with osteoporosis. This is not COVID and these new drugs have been around long enough to know what to expect. No one will give out rewards if you try to muscle through this without the benefit of drugs that are proven winners. You only get one life and for most of us by the time we get osteoporosis we are half way through our alloted years. Don't waste time. Be smart. The only consideration is cost if you don't have insurance. You may qualify for assistance from the manufacturer if you don't have insurance. Evenity is effective and my Dexa shows that. I believe it is safe or I would have found out by now ( I was a medical librarian before I retired and I researched medical literature and still do). I would trust a doctor who recommends Evenity before I would trust a doctor or anyone that promotes some supplement which has not undergone the testing and scrutiny of medicines in the U.S.

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@catharbert cat, once you finished evenity after the year. Could you ever go back to using evenity?? Can you continue to use Prolia to maintain your bone growth year after year??? I'm so stressed out...

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Profile picture for jimmy05 @jimmy05

@tsc Teri are you taking 70 mg once a week of alenondrate? Is it building new bone?? How have your T-scores been since using it?currently I'm on that until I see my rheumatologist on 11/12.. I'm 57 my last T-score was -2.7 in September..

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@jimmy05, I am still taking 70 mg of alendronate once a week. Next year I will have to stop after taking it for 5 years. I have had one Dexa scan. My spine improved to osteopenia, but my hips didn't. I'm probably due for a dexa scan this year.
I hope things go well for you!

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