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Husband ending Forteo, what next?
It has been suggested that when meeting with his specialist tomorrow virtually, I should ask these questions and then a summary of the three most common options after Forteo:
Instead of asking “what’s best,” ask:
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“Given his history, which option best preserves his bone after Forteo—and why?”
And maybe:
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“Would Reclast be a stronger option than Fosamax for him?”
Simplified
Reclast — strongest + simplest preservation
Fosemax — very good + most commonly used
Prolia — strong but requires careful long-term planning
I'd love to hear if anyone has had experience with these and what you feel is best - as well as questions for his doctor.
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Isabelle7, I'd be asking for bone markers CTX and P1NP before and following one or two months of the new medication.
The choice of a follow-up medication would be based on those and based on the dexa results.
Reclast can have some daunting side effects as can Prolia.
If your husband has had good effect with Forteo, you might want to try Fosamax. It isn't usual to have rapid bone loss after Forteo. If his bone density is low you might ask about continuing Forteo, or think about Tymlos or Evenity.
The bone markers before may help you decide if an antiresorptive would or an anabolic would be best.
They will also prevent your husband's taking a medication that is not effective for his bones.
When the specialist offers their opinion, ask about side effects.
If they suggest Reclast, ask if they will order a reduced dose and a long infusion to protect the kidneys and avoid side effects.
Before you decide tell us what this specialist says.
I always record the video consultations on my phone, not to catch the doctor, but to help me accurately process what they've advised.
I find it best to listen first and ask second.
You are organized though, should be easy.
@gently Here are his last scan Oct 2025 after a year and a half (almost) on Forteo. May will mark 2 years on Forteo. We were told he would have to stop for Teo after two years and would need to go on one of the other options. We were also told that Reclast is a good option but you’re sounding like that might not be the best option. We meet with the doctor in 40 minutes. Should I just ask for her opinion and then ask her to wait on prescribing until we have time to think about it and do some more research?
isabelle7, I would listen first because sometimes people don't hear you when they have something to say.
I only looked at the -2.6 for the hip because I only just saw your note and your appointment may be underway,
I'd consider another anabolic. Reclast might be the very best option. But there are some hazards with the drug.
So, yes I'd ask what options the doctor is willing to offer and then say that you would decide and contact her office, so you wouldn't be waiting for another appointment. I hope the doctor will work with you.
Isabell7, did the the Reclast option come with a consideration of GCA. https://pmc.ncbi.nlm.nih.gov/articles/PMC10960659/
I'm trying to ferret whether the risk of stroke with GCA is related to the warnings on Evenity.
We are no longer denied further Forteo use by FDA guidelines, though we still can be denied by our providers and/or insurance.
No BMD gain in the hips is typical of Forteo.
I hope you aren't in the "waiting room." Glad you have until May to decide.
We had a virtual visit with his specialist. He had PMR followed by GCA. Prednisone is what caused his osteoporosis.
Her recommendation is to start him on Fosamax and if he tolerates it we’ll go a month (no heartburn or joint pain) then when will switch him to Reclast.
Does that sound like a solid plan to you?
Can you please explain what you meant about Reclast and GCA? Sorry for all the questions.