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Hesitant to begin drug treatment for my osteoporosis
Osteoporosis & Bone Health | Last Active: Aug 10 5:31pm | Replies (288)Comment receiving replies
Thanks mayblin. I used the frax calculator and if I filled it out correctly, the ten year probability of a hip fracture is 2.4 and major osteoporotic is 11. I don’t know if those numbers are alarming or not.
My endocrinologist was set on getting me on meds: the first time I saw her, I told her that I was reluctant to take osteo drugs since I walk and lift weights/take multivitamins, calcium, k2, d3/eat healthy/on HRT everyday. She said I should be on meds and gave me a choice of 3—Fosamax, forteo or reclast. Then she wanted bloodwork (that’s another nightmare horror story about the phlebotomist at Labcorp) so at my next appointment, she prescribed Fosamax. I asked her if going on Fosamax was necessary because I showed bone growth and an improvement in my Dexa since I’ve been on HRT. She was adamant about taking the Fosamax. I haven’t started taking the Fosamax.
When I see my gyn, I will ask her if there’s an HRT she could prescribe with a natural form of progesterone.
Replies to "Thanks mayblin. I used the frax calculator and if I filled it out correctly, the ten..."
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I have a link for treatment guidelines compiled by NOF (National Osteoporosis Foundation), see slide page#18:
https://cme.nof.org/sites/default/files/Osteoporosis%20Guidelines%20and%20Clinical%20Practice-%20Singer.pdf
There are other guidelines available, which are generally similar, with some variation.
Each endocrinologist may recommend different pharmaceutical treatments based on his/her own clinical experience and judgement. This often leaves us patients with the decision of whether to follow our doctor's recommendation or to wait and consider other options.
Your calculated FRAX falls roughly in the middle range. For comparison, my FRAX was better than yours but my Lspine Tscore was lower at -3.4, so I decided to start Forteo shortly after diagnosis.
Given your endo's initial proposal, personally I'd choose Forteo (or Tymlos) in a heartbeat. You've probably read that sequencing matters (shown in the link). The timing of when to begin the pharmaceuticals also matter, and that decision is very personal.
I'm curious what led your endo to choose Fosamax. Would you mind sharing your baseline uNTX if you have it, and your lab's reference range for uNTX?
Based on the info I received from my two obgyns at different hospital systems, transdermal estradiol patch and micronized progesterone (both bioidentical) are generally considered safer than oral estrogen and synthetic progestins. This combination is favored by many doctors so it's worth exploring with your physician.
If Forteo (or Tymlos) ends up being your treatment choice, it's also worth discussing with your endo whether to use HRT concurrently.