Has this happened to you? BMD declines with both Prolia and Evenity

@kathleen1314 thanks for the comment. I’ve been taking NDT since 2008. I was also told TSH would be suppressed because of the t3. My tsh has been suppressed below 1 since starting it while trying to get my free T3 and free T4 in the right range. What would a good level of suppression be? If you have any articles handy, I would love to see any recent articles or trials you may have regarding overly suppressed TSH and the effect it may or may not have on bones.

Unfortunately, my osteoporosis continued to get worse and I had a hip fracture 2 years ago. I am now on Tymlos. Of course, we all have different health issues that may contribute to osteoporosis.

May I ask how suppressed your tsh is? I’m happy that your thyroid meds are working for you and that you have been able to improve from osteoporosis to normal! Not an easy feat.

@bluebonnet242
My current tsh is 2.02, but it has been as low as .01 in the past.
The crux seems to be the t3 supplementation; because the usual tsh rules are based on patients only on t4 not t3,

copilot says: “When you’re taking T3 or higher‑dose T4, TSH often goes below 1 and sometimes below 0.1. What matters more is that your free T3 and free T4 stay in range and that you feel well. TSH alone isn’t a reliable guide on combination therapy.”

You might ask copilot; it can search all available research and report to you.
I did ask copilot your original question and....
This is how copilot stated the conclusion after looking at your question:
“Those Google ranges are based on people taking T4‑only. When you’re on T3 or a T3/T4 combo, TSH almost always drops — sometimes below 1, sometimes even below 0.1 — without meaning you’re over‑treated. T3 suppresses TSH more than it reflects your actual thyroid status.
The key message from the research
TSH suppression by itself is not what causes bone loss.
Bone risk comes from excess thyroid hormone in the tissues — meaning high free T4 or high free T3, not a low TSH.
This distinction is crucial.

Research to back up the above:
Hoermann R, Midgley JEM, Larisch R, Dietrich JW. Homeostatic Control of the Thyroid–Pituitary Axis: Perspectives for Diagnosis and Treatment. Front Endocrinol. 2015.
• Hoermann R et al. Individualised requirements for thyroid hormone replacement. Eur J Endocrinol. 2013.

What matters more is that your free T3 and free T4 stay in range, your heart rate is stable, and you don’t have risk factors for bone or heart issues. Many people on combination therapy sit in the 0.1–0.5 range, and some go lower with normal labs and no symptoms. So the TSH number by itself isn’t the best guide when T3 is part of the treatment.”

Faber & Galløe, 1994 — “TSH suppression alone does not cause bone loss”

Mazziotti et al., 2010 — Review on thyroid hormones and bone
This review makes a very important point:
If FT3 and FT4 are normal, bone turnover markers remain normal.

Flynn et al., 2010 — Large population study (17,684 patients)
This is one of the biggest studies ever done on thyroid replacement and bone.
Finding:
• People with low TSH but normal FT4 did not have increased fracture risk.
• Fracture risk increased only when FT4 was high (overtreatment).

How are you going with your weight bearing exercises? How is your BMD ? I have refused these drugs over many years and have a very low BMD. I was diagnosed at 30 so have been refusing the drugs for 34yrs. There is a program called the ONERO program which was too much for me. At the end of 25 I started 1 day a week with an Exercise physiologist that works with older women with Osteo. I have read that your BD looks better on the tests after all these drugs but the bone itself becomes more chalky.

Yes, you would. 🙁

General practitioners and an endocrinologist missed how my old-school prescription issued 50 years ago was unecessary and harmful.

I uncovered it in my own research and find Google Scholar invaluable. Unfortunately, I've found many physicians' knowledge has not been current on an array of subjects, and it has been unusual for me to find one open to new information from a patient.

In my case,
even an endocrinologist suggested a medication withdrawal schedule that did not comply with standards.

As I recall, I advocated to reduce the hormones by a slight anount every few months. The doctor followed each reduction with a thyroid panel.

I believe I found the every few months time-line recommendation from the Society of Endocrinology. Although, I've read that it takes 4-6 weeks for thyroid hormone medication to exit the system.

I wish you the best!