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High anxiety regarding Reclast or Prolia decison for OP meds
Osteoporosis & Bone Health | Last Active: Nov 17 8:47pm | Replies (205)Comment receiving replies
Thank you so much for prompt response mayblin (@mayblin). I just wrapped 12 months of Evenity last month, not sure why my endo didn't request a mid-stream Dexa but going in for one today. Highly doubt it will meet "target" (and not sure what the target is in my case) as my scores were so bad ("severe osteoporosis") in first Dexa: L1 T-score -2.6, L2 -3.7, L3 -4.0, L4 -4.3; Left neck -2.9; Left hip -2.4; and FRAX 10 year probability of fracture: “not reported because some T scores…below 2.5”. So wondering if a second round of Evenity is going to be the recommended path--noting you say this is "tricky". I did just get a CTX test last month (801 pg/mL down from 1111 in May 2024). Have never done/heard of a PINP or phosphorus test to best of my knowledge--perhaps I should request? My big concern now is that I had last Evenity on 10/16 and am told need to start either Prolia or Reclast within 4 weeks which is next week! I'm 63, early menopause (@44) and never took HRTs (regretting that), have good insurance. Going in to a different Endo this afternoon for second opinion. Welcome any recommended questions to ask or tests to request!
Replies to "Thank you so much for prompt response mayblin (@mayblin). I just wrapped 12 months of Evenity..."
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@mayapath2health
It is great that you’re getting a timely DEXA. Hopefully the results will be available for your appointment with the new endo.
To me your CTX looks quite high right after completing 12mo Evenity, though your baseline CTX was very high. Without a corresponding P1NP, it’s hard to tell whether this is balanced high bone turnover or active bone loss, definitely ask about this at your appointment.
FRAX score can be calculated by using: https://www.fraxplus.org/calculation-tool
Many endocrinologists use FRAX in complicated cases to guide treatment decisions.
It’s easier for a decision if you just need to lock in gains.
If you need more bmd improvement based on your new endo’s assessment, it becomes a lot trickier. If this is the case, discuss all possible route, including the usual Reclast/prolia, the lesser used risedronate/raoxifene/estrogen and tymlos/forteo, for continued bmd improvements or as a “bridging” agent.
I’d also make sure there’s an open line of communication with your new endo, sometimes these visits go by quickly, and it’s hard to cover everything in one session, especially if follow-up appointments are months out.
Best of luck!