PCP Suggesting Meds for Osteopenia

The same thing happened to me. My Dexa scans showed osteopenia, but I got a L3 compression fracture while pulling myself out of bed after a total knee replacement. My primary care physician said that the fact that I got the compression fracture indicates that I should be treated as though I have osteoporosis. I think for both of us the proof is in the fact that we got the compression fractures. I believe that the fractures override the dexa scan results.

Thanks for replying! How you get the compression fracture matters, acc to my neurologist. (My PCP has different ideas on the matter! ) If the CF is from a bad fall & someone younger in the same circumstance would also sustain a compression fracture, then it doesn't bump you into the clinical osteoporosis category. I'm in a grey category & sticking to supplements for now. Vit D3, K2, Calcium.

Are you now taking any OP meds?

northrancher, I like your PCP's caution, and your decision.
Some of the osteoporosis medications can leave you worse off than if you hadn't ever taken them. There are two exceptions that you might look at that hasten the healing process and lessen the pain. Tymlos and Forteo. Forteo is sometimes prescribed for a brief period of time after a fracture and often after orthopedic surgery.
Vertebral compression fractures heal in a compressed state changing the balance in your spine, which can leave you a little more vulnerable. May you never fall again.

Agree with @gently! Best not to start on bisphosphenates in your circumstances, the meds can def leave you worse off, perhaps greater bone density but not necessarily bone quality, whereas the anabolic types help w the quality. Sounds like you have the kind of cautious thoughtful doctor we are all searching for! Have you checked out to see if there is an Osteostrong location near you? They (and other sources) can help you avoid falling or fall “better” if you do go down. Prayers for you!

You make a good point. The circumstances surrounding the fracture can make a big difference in the diagnosis.
I take alendronate 70 mg in addition to multiple vitamins with D3 and Calcium.

Appreciate the validation and thank you for the kind wishes:) I'm now at peace with my decision. My gut feeling, after doing a little research on the OP meds here, was that the side effects would outweigh the benefits. To hear you say the OP meds could leave me worse off was so helpful. If I'd had a fragility fracture, instead of a CF from a bad fall, I'd likely lean toward taking one of those entry level OP meds. My PCP said she'd start me on one of the biosphosphanates. Assuming Forteo & Tymlos are in that category?

My fracture is completely healed, confirmed by x-rays. I'm still in Physical Therapy to strengthen my core & taking Vit D+K2, AlgaeCal & tracking calcium intake. Walking, swimming. I'm surprised I'm even in this OP-vulnerable situation as I'm 5'9" was a student athlete (basketball), played tennis for most of my adult life & skied. No one in my family had osteoporosis, so I'm crossing my fingers that I'll stay in Osteopenia & watch my step.

Thank you! There is an Osteostrong near me and I've already called them. I'm open to doing whatever will keep me off OP meds, or at least delay them. My fall was due to my running to the bathroom (food poisoning) and slipping on a wet, marble floor. I went down so fast, there was no time to break the fall. Once down, I couldn't move & could barely breathe from the pain. I never want to experience that again.

I'm in Physical Therapy now, which has helped tremendously. My PT told me that he expects my complete recovery & return to the tennis court! Holding him to it!

Appreciate your good wishes & prayers 🙂

Gently,
Could you possibly explain the name the osteoporosis medications that can leave you worse off and what the complications are. And could you tell me where this information came from. I am taking alendronate and now I am concerned. I have tumors on my spine, and I want my spine to be as strong as possible, but I do not want some unexpected complications.

Thanks
Katrina 123

Katrina,
Most of the osteoporosis medications take you back to baseline, back to where you were before you started taking them. With most of the drugs that happens rather quickly.
Alendronate, however, probably the best medication (so far) for spinal tumors, leaves you with some protection probably for a lifetime. It attaches to the bone and stays there.
You've probably read the warnings about osteonecrosis with alendronate's class of drugs--the bisphosphonates.
Bisphosphonates have a completely different mechanism of action than Prolia. They collect bone. Over a long period of time that bone can become avascular and brittle. So with alendronate you have small risk of osteonecrosis (mainly of the jaw) and atypical femur fracture.
The medication that will leave the bone weaker if you take it and then stop is denosumab--Prolia. It is a very good drug to slow spinal tumors especially metastatic tumors of the bone. It just isn't safe to stop the drug.
Prolia works to slow bone turnover. It stops the cells that break down bone. It stops them just before they finish developing and store them. In storage they sometimes combine to form large, aggressive bone-dissolving cells. When a patient stops taking the medication, that collection of cells release on the bones causing multiple fractures.
If your tumors were metastatic tumors, Prolia would be well worth the risk, though you'd pray that you'd never have to stop taking it.
I take Forteo. In your situation I'd be on alendronate. I might consider the injectable bisphosphonate zoledronate, because of the risk of esophageal erosion with the oral bisphosphonates. The injectable bisphosphonates have a greater risk of long term reactions because they are readily absorbed from the bloodstream.
What type are your tumors and do you have any side effects with alendronate.
I have links, mostly pub med, but wonder which would advantage you.

I was considering Osteostrong until I read about people who experienced fractures during their sessions.