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@cat1203, i didn’t respond 'well' during my 1st yr on Forteo either: at 13mo, my lumbar gain was "only" 4.9% with a slight but insignificant bmd loss at the hip and femoral neck, and that was without any prior bisphosphonate treatment. Given your 3.5yrs on Fosamax, a 4.5% gain is actually a strong biological signal.
Have you done a BTM lab recently? If they still show a robust turnover state - especially when compared to your previous labs if you had them, it may be worth discussing an extended 3rd year of Forteo with your doctor. Considering your current TBS of 1.224, staying the course could allow for continued architectural reinforcement and mineralization.
FWIW, I was actually prescribed and approved for a 3rd year of Forteo due to my seemingly "delayed" response, though I ultimately chose not to pursue it because my BTMs were too high at the time. In the end, I had wonderful gains.
Just a thought!
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@mayblin thanks for your response and apologies for my delayed one. I've been away from the boards. In answer to your question, yes, I've had BTMs done recently, and they seem to indicate teriparatide is no longer working to build bone. Three months in on teriparatide my CTX was 431 and PN1P was 64. At 20 months CTX was 391 and PN1P was 60. Prior to starting teriparatide (after 3.5 years on Fosamax), CTX was 100 and P1NP 13. I think I've hit the point of diminishing returns with teriparatide. In the meantime, a new wrinkle: I apparently have hypercalcuria on the basis of my 24-hour urine catch done on May 22. It was high (264, the top of the high end of the chart is 250). I have an appointment with my rheumatologist tomorrow.
What do you mean by your BTMs were too high for a 3rd year of Forteo? How did you achieve your "wonderful gains in the end" since you chose not to do Forteo again?