Will your insurance cover an anabolic if your doctor supports it as a starting point. It is understood now that gains from an anabolic can be blunted if one has started treatment with a bisphosphonate. However, I am not a medical professional and I don't know your medical history. Sequencing is quite important with osteoporosis drugs.
@gravity3
Just learning that sequencing is important is good to know. Sounds like I am on a journey. I don't yet know what an anabolic is but I can certainly learn. Will do more online reading. Thanks for responding.
There are alternative medications. Ask your doctor if any other drugs are more appropriate for you. Fosamax is the first drug doctors automatically prescribe - often without consideration for individual needs.
Endo started me on Fosamax at first appointment. The only other drug discussed was Reclast and a once-a-year infusion scared me a lot (no stopping if you have a reaction/side effects) thus I "chose" Fosamax. He mentioned briefly he didn't like Prolia as you are "on it for life". Never heard the term bone builder or anabolic. I did end up on Reclast after 8 months of Fosamax (not good enough gains), I should know April/May if Reclast improved my osteoporosis. Something I learned over the past almost 2 years is that (shockingly!) these drugs may not do much. Prepare for that. Apparently not getting worse is a win. And yes, insurance companies do dictate what drugs the doctors get to prescribe sometimes; and it is more economical to try the older and/or cheaper first. I would like a choice; I would like my doctor to be able to prescribe the best solution out there and then I can decide if I can afford out of pocket for drugs insurance won't cover.
What are your DEXA scores and have you had any fractures?
Like you, my doctor recommended Fosamax (I can't take Tymlos or Forteo due to parathyroid issues). I have severe osteoporosis and decided not to take it based on articles I read that said it offers minimal fracture prevention benefits in postmenopausal women without a prior fracture or vertebral compression. It does make your DEXA numbers better because you retain old bone. The only reason I'd consider a bone drug was if it offered considerable fracture prevention, because isn't that the reason for taking a medication?
There are many articles about studies done on this, here is one: https://www.amjmed.com/article/S0002-9343(24)00101-3/fulltext
The last paragraph offers a summary of findings: "for patients with osteoporosis based on bone density alone, treatment benefits are less certain. Hip fracture risk reduction is modest and not supported in patients without a history of fracture. Reductions in vertebral fractures are substantial regardless of baseline risk, but whether these reductions correspond to less chronic pain and disability is unclear. Clinical evidence is weaker for newer agents. Future guidelines and reviews on osteoporosis treatment should clearly distinguish between primary and secondary prevention of fractures to best inform clinical decision-making. Despite guideline recommendations and calls for more screening and treatment, there are legitimate reasons for some clinicians and patients to opt out."
Are you seeing an endocrinologist or a physician who is trained in treatment of Osteoporosis? Do your own research so that you can engage you provider in meaningful discussions about the types of drugs available, their function and possible side effects along with treatment plan and sequencing.
Physician is Internal Medicine doctor. The more I am learning from this site the more I realize that this is complicated. I will seek out a specialist as well as continue to learn all I can.
judithsmiles, we basically have two types of medications for osteoporosis. The anabolic that assemble complex proteins to build new bone and antiresorptive that prevent the resorption or loss of damaged bone.
All the bisphosphonates Reclast, Fosamax etc and Prolia are antiresorptive. The stop bone from breaking down. The stop damaged bone from breaking down and by collecting this bone, they increase bone density. Which does make your bones less likely to fracture. This bone is more brittle has fewer blood vessels and nerves, creating some risks for atypical femur fracture and osteonecrosis of the jaw.
Evenity is the drug considered both antiresorptive and anabolic. The bone building happens in the first three to six months and after the drug acts more as an antiresorptive.
Forteo and Tymlos are considered the anabolic (my favorites). They replicate the normal function of bone. They encourage the breakdown of fissured and otherwise damaged bone and facilitate the build up of new remodeled bone.
Both Prolia and Evenity add new bone on top of damaged bone.
Some Internal Medicine doctors understand the drugs and you might ask yours to if they would consider prescribing Forteo.
You might also ask if they will order bone markers. Some drugs don't work for some of us. And some of us end up on drugs for years that are not protecting our bones. Bone markers before the medication and after a month or two will show you whether you should keep taking the medication.
Keep posting before you decide so we can warn you about the dreaded side effects.
Best wishes
@gravity3
Just learning that sequencing is important is good to know. Sounds like I am on a journey. I don't yet know what an anabolic is but I can certainly learn. Will do more online reading. Thanks for responding.
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@gravity3
Just learning that sequencing is important is good to know. Sounds like I am on a journey. I don't yet know what an anabolic is but I can certainly learn. Will do more online reading. Thanks for responding.
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2 Reactions@nycmusic
Thanks for the advice. I will learn more. Doctor is Internal Medicine and her ordering the Dexa Scan was at first visit.
There are alternative medications. Ask your doctor if any other drugs are more appropriate for you. Fosamax is the first drug doctors automatically prescribe - often without consideration for individual needs.
@jozer
Yes, it is important to keep in mind that drugs like Fosamax are intended to reduce bone loss. It does not build bone.
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Thanks for the links! So much to learn! I appreciate not having to search out this all on my own.
I have not had a fracture. This is based on the T score alone. My doctor is an internist - Internal Medicine.
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Physician is Internal Medicine doctor. The more I am learning from this site the more I realize that this is complicated. I will seek out a specialist as well as continue to learn all I can.
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1 Reactionjudithsmiles, we basically have two types of medications for osteoporosis. The anabolic that assemble complex proteins to build new bone and antiresorptive that prevent the resorption or loss of damaged bone.
All the bisphosphonates Reclast, Fosamax etc and Prolia are antiresorptive. The stop bone from breaking down. The stop damaged bone from breaking down and by collecting this bone, they increase bone density. Which does make your bones less likely to fracture. This bone is more brittle has fewer blood vessels and nerves, creating some risks for atypical femur fracture and osteonecrosis of the jaw.
Evenity is the drug considered both antiresorptive and anabolic. The bone building happens in the first three to six months and after the drug acts more as an antiresorptive.
Forteo and Tymlos are considered the anabolic (my favorites). They replicate the normal function of bone. They encourage the breakdown of fissured and otherwise damaged bone and facilitate the build up of new remodeled bone.
Both Prolia and Evenity add new bone on top of damaged bone.
Some Internal Medicine doctors understand the drugs and you might ask yours to if they would consider prescribing Forteo.
You might also ask if they will order bone markers. Some drugs don't work for some of us. And some of us end up on drugs for years that are not protecting our bones. Bone markers before the medication and after a month or two will show you whether you should keep taking the medication.
Keep posting before you decide so we can warn you about the dreaded side effects.
Best wishes
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4 Reactions@judithsmiles This is a good layman's overview of osteoporosis:
https://my.bone-guide.workers.dev/
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2 ReactionsI've had a bone density test. Should I have a DEXA test before making any decisions?
DEXA or DXA is the most common bone density testing. Did you have REMs, QCT or QUS.
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