Teriparatide and transition after 2 years

Mary, it is most common to take a Reclast injection for each of the two years after teriparatide. You'll have two years to research alternatives. And in two years there may be even more alternatives than those we are currently prescribed.
Osteoporosis isn't thought of as curable (yet). We look at continuously treating osteoporosis in some way for the remainder of our days. Some patients are discovering that a single injection of Reclast is effective for two years. And some are returning to teriparatide after Reclast.
I have a brilliant friend who has maintained her gains from teriparatide with bioidentical hormone replacement. The endocrinologist I see after threatening me with Reclast for two years, suddenly decided that I should stay on teriparatide indefinitely.
You might ask your endocrinologist to order bone markers. They can ascertain that a medication is working for you so that you. They will also tell you after a year of Reclast if you need the second injection.
I have used the Alvogen teriparatide, intermittently with Forteo, and haven't noticed a difference.
Your research has led you to the very best osteoporosis medication.

Welcome to the best forum on Earth imho:) Looks like you have already made a good start in researching what is best for YOU! Don’t let the insurance companies dictate! Your doc’s office can fight for you as long as you stay determined. Good luck!

@gently Thank you for your response. I have read many of your posts and you certainly are knowledgeable. I so appreciate you taking the time to share your knowledge and experience.

@shocknot26 I agree, this is the greatest forum! Thanks for your input, you are right about the insurance companies,

@gently Are you sure you can stay on teriparatide indefinitely? I believe it is only for 2 years. I asked my MD if I could stay on Tymlos for longer than the 2 years and he said he didn't think it would be safe for the body.
However it appears that for my final year I will have to switch to teriparatide as Tymlos no longer covered by my drug plan.

lightlifts, there aren't clinical trials on extended use of either Forteo or Tymlos.
The effectiveness of the medications seems to wane at 18 to 24 months. The way that is measured in the trials is with the relationship of surrogates for osteoblast and osteoclast production and resorption of bone --P1NP and CTX.
The endocrinologist I see orders those serum markers every three months to ascertain that Forteo is still effective for my bones.
Eventually I may have to stop, or, eventually, I may experience an unanticipated harm.
Originally the trials were halted and black box restrictions were placed against longer use because rats in the study developed cancer of the bone. Later it was determined that the rats had a genetic tendency to cancer of the bone. Those rats continued to develop cancer without Forteo, while, they note that in twenty years of use no human and no monkeys developed cancer of the bone.
But, the humans didn't continue to take Forteo over the 2 year limit. And because where dna replicates the fastest there is the greatest chance for the misfolding that can result in cancer.
My own speculation leads me to think that it is possible that I will develop hypercalcemia, maybe chronic. or that the parathyroid gland lulled into inactivity by the injection of the hormone might be lulled into senescence
Many websites and many healthcare professionals are not aware that the FDA has lifted the warning about cancer. I'd be curious about any thinking on why it might be unsafe for the body.
If any of this is unclear, or if you want links, I'm happy to respond,
I hear of other osteoporosis people on extended use of these two pth medications, but I don't think it will ever be trialed.
These drugs work in the natural way that our bodies keep the bones strong through out our lives. You could think of Tymlos or Forteo as hormone replacement.

@gently My improvement on Tymlos waned significantly in the second year, so much so that the doctor was fine with me stopping after 21 months. The problem is that we don't have studies on extended use of Tymlos or Forteo in humans, so we don't really know what the risks are.

Are you still gaining bone density? If not, then what is the goal of taking Forteo? Just to maintain what you have?

Hi, njx58.
the goal for all of us is to avoid fracture. Maintaining the existing strength of bone could be a sufficient goal for those with greater strength than my bones have. I see advantage in maintaining that strength through the natural process of bone replacement that the pth drugs replicate. I see less advantage in maintaining bone mineral content with methods that stop or slow the process of bone turnover.
To answer your question rightly, I have to untangle a couple of premises prompting your question or at least the language of your question.
Dexa doesn't measure bmd. To quote my favorite bone expert "There is no universe in which mass over area is a unit of density." Density is a unit of mass over volume.
Dexa measures bone mineral content. Bone mineral content can be a measure of strength, not the only measure and in some cases, and with some of our medication as in when mineral replaces the area reserved for blood and nerves the bone becomes very brittle and weaker with greater bone mineral content.
The pth medications for osteoporosis work slowly. carefully rebuilding the collagenous structures that calcium attaches to, reconstructing the osteon channels that house the nerves, the communication channels between exercise and development of bone.
Reflecting on my experience might be too anomalous to advantage anyone, because of dexa numbers affected by radiation before starting osteoporosis medications. Radiation beams through the measured areas in the lumbar spine had hip could make Forteo look miraculous, while the numbers might actually reflect resolution of bone marrow edema or fat filtrates, a process unrelated to the medication
Anyone not using bone markers might have given up on the medication in the second year.
Without gaining bmd or bmc increase the goal of taking Forteo, for me, is to maintain the rigor of the life I've chosen without experiencing fracture, by restoring lost trabeculea, restoring haversian channels, to have bone that is flexible and integrated.
My bone mineral content gains aren't negligible, but aren't amazing, either. I add, yet.

I am on Teriparatide from PRASCO and a transdermal estradiol patch 0.025 mg. My insurance, UnitedHealthcare Medicare Advantage, I believe, has a $ 2,500 limit for Rx drugs; after reaching that limit, it turns into what is called the catastrophic stage, when I pay $0 for Rx drugs. My recent bone markers and bone marker ratio came back with very promising results compared to my T11 fracture results. Because my initial results were in the good range (BMR 180 ng/mL) and DXA was at a barely osteoporosis level, I am contemplating gradually stopping teriparatide, but doing it three times per week, then twice per week, and staying on an estradiol patch forever. Even though 0.025 mg of an estradiol patch is a low dose, I hope it will be helpful to keep up bone density gain at an acceptable level, but of course, after lab results.

@gently thank you for your response. Due to the fact that there isn’t any data on long term use is the reason why my MD will not recommend it past the 24 months.
I am aware of the prior black box warning and it is comforting that the rats went on to have cancer anyway, lol.
May I ask if you are a medical professional?
Best of luck to you on your journey!