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When to start vs delay prescription meds for osteoporosis
I would like to hear comments especially from those who may have waited to start prescription meds and see if you're glad you waited. I know everyone's reasons and circumstances likely differ widely. I'm 70 years old. I've had bone density scans every 2 years for at least 5 years and all show numbers for osteopenia. My worst T-score is -2.3 in my left hip. Last scan was March 2025. But each scan shows some worsening in numbers. My PCP has always just sent a letter saying I'm at moderate risk for fractures and to take my calcium and Vitamin D. That's it. But I finally looked at all of the scans over the years again and realized that I need to get proactive.
Back in May, I tried to get an appointment to an endocrinologist, and restricted myself to a female doc that wasn't an hour's drive away, I could only get in to see someone Dec. 1, so I made the appointment. But then I found a PA in an orthopedic surgeon's office who was a certified bone densitometrist and I could get in in July, so I also booked an appointment with her and saw her mid-July. She asked if I'd ever had a fracture and I said I thought I'd broken a rib when I fell power walking about 4 years ago, but I never saw a doctor about it. She said that fracture would put me in the osteoporosis stage even though my numbers don't show it. She also said that resistance training and other exercises for bone strengthening only improve bone density about 2% and while she said it's good to do the exercises, she said that medication was what I needed. She gave me 3 possible meds to consider, Fosamax, Reclast or Tymlos. My issue is that I am a full time sole caregiver for my husband who has terminal cancer and needs help. I take him to numerous medical appointments at MD Anderson. I help him with bathing, meals, meds, dressing, etc. I'm afraid of the side effects of the meds, and even though I know not everyone gets them, I am concerned that if I was unlucky to get side effects, then I may not be able to help my husband sufficiently, especially if I were to suffer any prolonged time with painful side effects. I don't know if I want to take that chance and not be able to take care of him. He has declined enough that I really wonder if he'll have another year left. He's lost 50 pounds in the past year. He's dependent on a walker and the chemo has caused heart failure. So I'm leaning toward not doing any meds and asking the endocrinologist that I will see Dec. 1 to get me a PT order to do resistance training and weight lifting at least twice a week to make sure I'm using proper form and staying safe. I don't know how long Medicare would cover something like that, but it would be less expensive than going with a personal trainer and who may not be experienced working with people with osteoporosis. I'd recently had PT on me knee for a bone spur and after going twice/week for 4 weeks, my cost was only $29.29. In the meantime, I try to go to the gym twice/week and do the machines for resistance training and use the treadmill.
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@tillymack wow! What a story-and thank you for sharing! May I ask how you did on Evista? How long did the docs keep you on it and how did your DEXAs turn out? Have you had to do anything since? From what I can see, that is more of a HRT drug, since it is an estrogen receptor modulator, right? I am wondering why my gyn didn’t mention it…..sorry for the barrage of questions. I think I am going to be known as the “question lady” on this forum pretty soon! LOL. There is just so much to learn!
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1 Reaction@bellae2156
Yes, I did hear the same. What drug will you choose. So afraid of all of them
@shocknot26 I don't actually remember when I started Evista but think I must have been taking it for 20 years or so. I experienced no side effects. I assume my DEXA scan scores dropped gradually and I decided to see an endocrinologist 4-5 years ago when they reached osteoporosis territory. It was my impression at the time that Reclast was the most benign of what was available, so I went with that for 4 annual infusions. When my scores stopped improving, I chose the Menostar patch and await my first DEXA scan in a few months to see the results. I expect to be on some med to support my bones indefinitely.
Questions are fine!
Note: I understand why you thought that, but Evista is not a type of HRT.
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1 ReactionI hope you can too! I didn't want Prolia because if you stop it (the way I understand it) you have an even greater risk of fracture. If that's not right, someone please correct me; I certainly don't want to spread false information!
Also, it's expensive, and my insurance won't cover it. I thought I might do Reclast, but someone on this list had a horrible experience with it. And, it would be in my system for a whole year, so if it's bad - I'm in for a year of "bad."
Fosomax is the other option my doctor suggested. I don't mind sitting up after I take it, and I can live with no coffee or food for a half hour. But I do have indigestion sometimes, and I am afraid it would irritate my esophagus and stomach after a few doses. But then, I could discontinue, since it is weekly. (Also, someone on this group said it is actually better to wait 3 or 4 hours to eat and drink anything other than water, but they don't want to tell you that because people would be less likely to do it).
I don't know a thing, really; I am just trying to find answers. I was surprised when my doctors wanted me to get a bone scan and very surprised when it turned out to show I was in danger of fracture.
@bellae2156 , I know she is wrong about just exercise! I'm 63, and I had 11% increase in BMD in my spine over 19 months from just exercise and nutritional changes, proven by 3 dexa scans (same center, same machine, same tech) over that time period and continuing dexa increases since then (after I started Tymlos). That equals 6.9% a year. That said, my exercise was a lot, with decently heavy weight lifting 3x a week, and treadmill, PT exercises, pickleball and stretching, totaling about 20 hours a week. I built up to it over time, and it's a lot, but I'm determined to get the best BMD I can while I am still able to move freely, and before I have to stop Tymlos.
Tymlos is giving me even greater % gains, so I feel like the effort is worth it.
Don't let your bubble be burst! We Bone Warriors are up to the fight! You got this!
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6 Reactions@boneoptimist That's really great to hear! Not just for you but very encouraging for me. I will continue to push forward on exercises and increase my protein. Thanks!
@bellae2156
May I ask how you fractured?
@boneoptimist
Great attitude. What will you do after Tymlos ? Live alone. Scared of so many side effects. Bad teeth. Believe to be at risk for MRONJ. Thoughts??
I fell when out power walking. Tripped. I attempted to fall to my left
side, tried to cushion my fall by putting my arm beside me and my momentum
likely caused me to fall harder. I'm pretty sure I broke at least 1 rib
because I couldn't lie on my back, turn from side to side in bed normally
or take deep breaths for about 8 weeks due to the pain when trying to do
so.
Anne Bell
512-736-1156
@bellae2156
Awful. Hope you get stronger and stronger. Scary. I’ll keep
Your number. Thanks
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