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What is next if Forteo does not work?

Posted by redlo @redlo, Dec 12 12:19pm

I just received my dexa after 14 months of forteo. No gains at all, BUT,...
My doctors both McCormick and my endocrinologist said that my bone markers showed it was working and want me to go the full 24 months. My
: CTX pre Forteo 99 now750 and p1np pre Forteo= 20, June 2025= 325 I go in this month for new blood work .( I have not got back my P1NP but my CTX just came in at 1252. I had 10 months of Fosmax before I started Forteo. Possibly the slowed the reaction to forteo? They assured me it was working. So worried my bones will never improve.
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soggybones | @soggybones | Dec 14 4:43am
In reply to @lightlifts "Maybe by then they'll be something after Prolia!" + (show)
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Maybe by then they'll be something after Prolia!

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@lightlifts God, I hope so! I'm only 59. None of these meds can be taken forever and I don't know what will happen to me once I've exhausted all my options.

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redlo | @redlo | Dec 14 9:39am
In reply to @mayblin "Hi redlo, I have a couple of questions if you don't mind. Was the DXA you're..." + (show)
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Hi redlo,
I have a couple of questions if you don't mind. Was the DXA you're using as baseline done before or after Fosamax? Also, when was the CTX of 750 measured? From what you wrote earlier, I wasn't completely sure of the timing.

It's quite possible that prior Fosamax use is contributing to the lack of measurable BMD change so far, even your bone markers showing good anabolic activity with Forteo. If you happen to get a newer P1NP at some point, would you mind keeping us updated?

Just to share my own experience: my response to Forteo was on the slower side too. After 13.5mo, my lumbar spine BMD was up about 4.9%, but there was essentially no change in BMD at the hips or femur necks. My P!NP at 13.5mo was very high (400+) showing great anabolic response btw. It wasn't until the second year and well into the antiresorptive phase when I saw much more noticeable BMD improvements across all sites. And that was without any prior treatment before starting Forteo.

From what I've read, newly formed bone matrix (osteoid) could take time to fully mineralize, so DXA changes could lag behind the responses we see in bone markers. In that sense, a flat scan results at this stage doesn't rule out meaningful improvement underneath.

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@mayblin
Thank you for responding and sharing.
Yes, my baseline dexa was after Fosamax.
April 2025 CTX 750
November 2025 CTX 1252
P1np June 2025 325
I go back in for my P1nP this week. I will post when I receive the results. I have to request the P1NP separately every time. They do not include it it on my on Quarterly blood work. It was McCormick that insisted I get it. Wish I had more confidence in my doctors here.

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redlo | @redlo | 4 days ago
In reply to @mayblin "Hi redlo, I have a couple of questions if you don't mind. Was the DXA you're..." + (show)
Profile picture for mayblin @mayblin

Hi redlo,
I have a couple of questions if you don't mind. Was the DXA you're using as baseline done before or after Fosamax? Also, when was the CTX of 750 measured? From what you wrote earlier, I wasn't completely sure of the timing.

It's quite possible that prior Fosamax use is contributing to the lack of measurable BMD change so far, even your bone markers showing good anabolic activity with Forteo. If you happen to get a newer P1NP at some point, would you mind keeping us updated?

Just to share my own experience: my response to Forteo was on the slower side too. After 13.5mo, my lumbar spine BMD was up about 4.9%, but there was essentially no change in BMD at the hips or femur necks. My P!NP at 13.5mo was very high (400+) showing great anabolic response btw. It wasn't until the second year and well into the antiresorptive phase when I saw much more noticeable BMD improvements across all sites. And that was without any prior treatment before starting Forteo.

From what I've read, newly formed bone matrix (osteoid) could take time to fully mineralize, so DXA changes could lag behind the responses we see in bone markers. In that sense, a flat scan results at this stage doesn't rule out meaningful improvement underneath.

Jump to this post

@mayblin
Hello
I Just got my p1np back yesterday. Little concerned it was 314 whereas June 2025 it was 325. I had a migraine when I took my blood test. Wondering if that could that affected the slightly lower score? Placed a call to have consultant with the McCormick . Distressed there won't be options for me.

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njx58 | @njx58 | 4 days ago
In reply to @redlo "@mayblin Hello I Just got my p1np back yesterday. Little concerned it was 314 whereas June..." + (show)
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@mayblin
Hello
I Just got my p1np back yesterday. Little concerned it was 314 whereas June 2025 it was 325. I had a migraine when I took my blood test. Wondering if that could that affected the slightly lower score? Placed a call to have consultant with the McCormick . Distressed there won't be options for me.

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@redlo I don't think 314 vs. 325 is meaningful. You could well have gotten a different number if you tested the day after getting a 325. These measurements can vary day to day, even hour to hour.

Also, P1NP doesn't always tell the whole story. Nine months after I started on Tymlos, my P1NP had gone up, but not by a ton. McCormick even told me that my DEXA might be disappointing. Instead, it showed a 15% gain. McCormick told me "it's nice to be wrong sometimes." 🙂

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mayblin | @mayblin | 3 days ago
In reply to @redlo "@mayblin Hello I Just got my p1np back yesterday. Little concerned it was 314 whereas June..." + (show)
Profile picture for redlo @redlo

@mayblin
Hello
I Just got my p1np back yesterday. Little concerned it was 314 whereas June 2025 it was 325. I had a migraine when I took my blood test. Wondering if that could that affected the slightly lower score? Placed a call to have consultant with the McCormick . Distressed there won't be options for me.

Jump to this post

@redlo I agree with @njx58 that the most recent P1NP drop is nothing to worry about - a 3% shift could be day-to-day or testing variation. Your formation levels are still very robust. However, the jump in CTX to 1252 is meaningful, it suggests the "anabolic window" might be starting to narrow, but more importantly, any lingering effects of fosamax are finally overpowered by Forteo.

The BTMs proves you are a strong responder. Very likely you have a large amount of newly formed osteoid (soft scaffolding) just waiting to be mineralized. When that happens, your dxa will finally move.

It makes sense to complete the Forteo course, but I also agree it's time to start thinking about a plan B in case your bmd doesn't reach target by the end of treatment. With the help of your endo and McCormick, I'm curious which path you'll end up choosing after Forteo, whether that's extending Forteo, moving to an anabolic-to-anabolic sequence (switching directly to Evenity ), or transitioning to an antiresorptive.

Wishing your bones a massive 'mineral harvest' soon!

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