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Reclast vs ?
Hello!
Does anyone have any insights on my dilemma?
My past 2 dexa scans done a year apart show very mild osteopenia in hip and spine but osteoporosis (-4.1) in forearm. My TBS score shows normal bone structure, no osteopenia or osteoporosis. My doctor is telling me I need to do the Reclast infusion. She is not offering any pill form whatsoever and told me Reclast is basically the only way to go.
I am a very active, fit 65 year old. I am considering a REMS scan to sort out what is going on with my forearm. My endo didn’t have any good info on it and said DEXA is the way to go when diagnosing and prescribing. I have never fractured a bone. I am not looking to bring on new problems due to side effects. In the past I have reacted to a booster for whooping cough- full body rash for over a year, terrible experience that I have no desire to repeat.
I am hypothyroid and have been on synthroid for many years now. My calcium intake has not been great, sporadic at best, but committed now to improvement.
If anyone has any thoughts or past experiences that might help in my decision I thank you in advance!
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Hi @maloc, i came across this review article "New Challenges: Use and Interpretation of Radius Bone Mineral Density", and thought it might be of interest to you:
https://pmc.ncbi.nlm.nih.gov/articles/PMC11651675/
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1 Reaction@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?
@cat1203
Your bone turnover markers at 20mo Forteo does appear to be plateauing (or returning to the levels at 3mo), which suggests that extending Forteo will likely yield diminishing returns just like you’ve mentioned. If the goal is to maximize BMD before transitioning to an antiresorptive to preserve those gains, then switching from Forteo to Evenity makes most sense. Here is an observational study by Ebina et al. that compares Evenity's effectiveness across different prior treatments - it shows the best responses in treatment-naïve patients, followed by prior Forteo, then bisphosphonates, then Prolia. I think this is directly relevant to your situation:
https://pubmed.ncbi.nlm.nih.gov/34020048/
Sample size for teriparatide group is small though.
In my case, both BTMs trended down during the second year of Forteo. At 22mo, CTx trended back up to 800 indicating that bone resorption was beginning to outpace bone formation (137). By transitioning to HRT, estrogen slows down osteoclast activity, ensuring that the newly formed osteoid is subjected to less degradation and can undergo complete secondary mineralization. This explains the significant BMD gains observed during my antiresorptive (HRT) phase, which makes perfect sense based on what my endo explained and what I've been reading.