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Looking for cases of people using a second anabolic after the first
Osteoporosis & Bone Health | Last Active: Jun 15 9:34am | Replies (24)Comment receiving replies
cat1203, teriparatide and romosozumab work through entirely different mechanisms. Evenity may well work for you if Forteo hasn't.
I responded to suggest that you use bone markers to determine if the medication is effective, so that you don't spend a year on Evenity either uselessly or worrying. Having a serum P1NP before Evenity and a month in would let you know. Some like the second P1NP two months in but I'd be insistent not wanting a second injection without knowing. The jump in P1NP will be dramatic, even after successful use of Forteo.
Even further from your question (sorry), I think of Forteo, when is doesn't work,as a valuable hint that you may have secondary cause for osteoporosis which should be resolved before resuming medication, the main concern would be hyperparathyroidism.
I wonder from your post if you had some, but not enough gain from Forteo. I'd have quit Forteo after the first dexa if I didn't have bone markers telling me that this drug was doing some heavy lifting. Even after the second dexa when the only remarkable change was a change in fracture risk, I may have quit.
Forteo does something that Evenity can't. It rebuilds the cartilage structure in trabecular bone lost in the breakdown of bone. Cartilage isn't evidenced on dexa. I reasoned that Forteo is busy rebuilding cartilage, because I'd lost a whole lot before starting medication. I'm on extended Forteo.
You are on unchallengeable ground asking for bone markers after (wasting) 17 months without evidence of gain
I suspect you'll have good results on Evenity in no small part because of prior Forteo use.
Replies to "cat1203, teriparatide and romosozumab work through entirely different mechanisms. Evenity may well work for you if..."
Hi gently, may I ask why your on extended Forteo?
I'm on my 24th month of Forteo (not generic teriparatide). My DEXA shows a 12.7% in my spine (-3.4 to -2.6), 2.8% increase in hip, 8.4% increase in femoral neck, 3.9% decrease in forearm. Per my discussion with Dr McCormick two years ago I'm not surprised by the hip and forearm area. The current plan is to move to Reclast to lock in the gains. I meet with my endo in two weeks to discuss next steps. I really don't want to go on another med (e.g. Evenity). I'm hoping my endo doesn't go there.
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@gently I had some gain from Forteo, but only in my spine, going from -3.8 to -3.5, a 4.6% increase. My left total hip and left femoral neck were unchanged, at -2.2 and -2.6, respectively.
My TBS score is 1.223, which is degraded microarchitecture, same as before.
My former rheum did not use BTMs to guide clinical treatment, which as I'm sure you know is not uncommon. I ordered and paid for them myself before starting on Forteo. CTX was 100; P1NP was 13. This was after 3.5 years on Fosamax.
Three months after starting Forteo, I had BTMs done again. CTX now 431 and P1NP 64. Since my rheum offered no interpretation, I relied on Dr. AI, which said "increased CTX is normal in the early stages of treatment with teriparatide. A higher CTX number after 3 months on teriparatide is expected because this medication primarily stimulates bone formation, which initially leads to a temporary increase in bone resorption (as measured by CTX) as the body starts the remodeling process to build new bone, even though the net effect is a gain in bone density over time; essentially, teriparatide "primes" the bone to rebuild itself by increasing bone turnover, resulting in a higher CTX level early in treatment. When monitoring P1NP levels while on Forteo (teriparatide), a significant increase of more than 10 µg/L from your baseline level after 3 months is generally considered a positive response, indicating that the medication is effectively stimulating new bone formation; this is often used as a benchmark to assess treatment efficacy. " So it seemed to me the Forteo was working.
I had no other BTMs and my DEXA on 3-12-26 was my first one since 3-11-24. (My very first DEXA on 10/27/2020 had my femoral necks at -2.3 and lumbar spine at -3.8, at which point I went on Fosamax. I might have quit Fosamax sooner had I had a DEXA two years later in 2022 but my PCP--I wasn't seeing a rheum at that time--never suggested it and I didn't know any better.)
I too wondered about underlying causes such as hyperparathyroidism for which I was tested prior to starting Forteo. Normal.
I am hopeful my new rheum, who I can't see until late May, uses bone markers and will agree with me about another, different round of anabolic, i.e. Evenity.