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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
@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!
Replies to "@mayapath2health It is great that you’re getting a timely DEXA. Hopefully the results will be available..."
@mayblin Hello...so my DEXA came in on Friday and is as follows:
Nov 2025 (63 yo):
Spine: BMD is measured in L1-L4.
T-Score: -2.7
Z-Score: -1.1
Change versus previous: 16.8%*
Left Hip: T-Score of hip is lower in femoral neck.
T-Score: -2.1
Z-Score: -0.7
Change versus previous: 9.3%* (total) Change versus previous: 16.5%* (femoral neck)
As reminder my January 2024 DEXA was:
Age 61
Spine L1-L4: T-score -3.7; Z score -2.2
L1 T-score -2.6; Z score -1.3
L2 T-score -3.7; Z score -2.2
L3 T-score -4.0; Z score -2.5
L4 T-score -4.3; Z score -2.7
Left neck: T-score -2.9; Z score -1.5
Left hip: T-score -2.4; Z score -1.4
FRAX 10 year probability of fracture: “not reported because some T scores…below 2.5”
L3 T-score -4.0; Z score -2.5
L4 T-score -4.3; Z score -2.7
Left neck: T-score -2.9; Z score -1.5
Left hip: T-score -2.4; Z score -1.4
FRAX 10 year probability of fracture: “not reported because some T scores…below 2.5”.
I also had Osteocelin results: 22ng (in 2024 had been 17 ng).
Dr is suggesting Prolia...and have scheduled for this afternoon as it's already 4+ weeks since completed Evenity and he said important to not let slip. Any last minute thoughts? I can cancel Prolia appt but hard to get another?
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@mayblin They said 3-4 weeks for DEXA results. Ugh. Am going to see if my Endo can expedite as decision needed on next steps sooner than that. Will ask new Endo re CTX/P1NP. When I calculated FRAX it only calculated for femoral neck (not my super bad spine) and gave me 10 yr probability of major osteoporotic of 14% and hip fracture 3.6%...but that was using data prior to my rib fracture (bent over and twisted to get something in a tight airplane seat about 9 months after the DEXA and broke two ribs)...if I add that factor (again was 9 mos after the scan) it moves to 23% and 6.4%. Likely I am going to be one of the 'trickier' cases. Scary.