Teriparatide and transition after 2 years

Posted by Mary @mjb24, 6 days ago

I was diagnosed with Osteoporosis 3 weeks ago and my doctor wanted me to start on Prolia. I held off because I needed time to digest this diagnosis and research Prolia. I have spent the past 3 weeks researching Prolia along with the other available medications, exercise, vitamins and supplements. This forum has offered so much and has been a big help! At the start, I was in denial at having to take another drug but I am coming to the realization that I may need to do this. I am leaning toward Forteo, however, my insurance will only cover an alternative teriparatide by Alvogen. My question is after the teriparatide I understand the need to transition to another drug to seal in the gains. For that I am looking at Reclast. But for how long do you have to remain on Reclast or another drug?

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

lightlifts,
thank you for asking. I have no medical background.
Cheers to your doctor. I don't think our medical professional should experiment with us.
I'm going to need this luck you're sending.
Bless your bones.

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Profile picture for lightlifts @lightlifts

@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!

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@lightlifts I greatly respect gently 's opinion, and her decisions for her own care, but she is just speculating on the long-term benefits and possible side effects. No offense meant at all, but all she can do is speculate since there are no studies. That's her choice.

I personally would not use Tymlos for more than two years. If it hasn't been studied, I'm not going to make myself the guinea pig. I got great results in the time I took it, and I'm satisfied with that. I'm happy to not be taking it any longer.

P.S. you mentioned your drug plan. You can sometimes get approval for an exception if you've been taking the medication. Most insurers don't expect you to switch drugs mid-stream for something you're taking for just a year or two. Is this a Part D plan or just regular insurance?

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njx, I was curious about your results and if you have transitioned to another medication. I think that osteoporosis is quite different for a man, partially because bioidentical hormone replacement is so much easier to obtain for males.
Did you use bone markers. It would be interesting to see your numbers. Is your preference to keep them private?

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Profile picture for njx58 @njx58

@lightlifts I greatly respect gently 's opinion, and her decisions for her own care, but she is just speculating on the long-term benefits and possible side effects. No offense meant at all, but all she can do is speculate since there are no studies. That's her choice.

I personally would not use Tymlos for more than two years. If it hasn't been studied, I'm not going to make myself the guinea pig. I got great results in the time I took it, and I'm satisfied with that. I'm happy to not be taking it any longer.

P.S. you mentioned your drug plan. You can sometimes get approval for an exception if you've been taking the medication. Most insurers don't expect you to switch drugs mid-stream for something you're taking for just a year or two. Is this a Part D plan or just regular insurance?

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@njx58 I can pay a little more for a different part D plan and have Tymlos covered. May I ask what you personally transitioned to after the Tymlos, and if you had good results? I can't take oral bisphosphanates, don't want Prolia lifelong not sure what to do. Reclast infusion scary to me. TY

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lightlifts, I've only taken one osteoporosis medication. I'm on extended Forteo--the other pth drug similar to Tymlos. I felt the same way you do about Reclast. I wanted either Forteo or Tymlos with a transition that didn't involve Reclast. At the time the endocrinologist I see adamant the I would be on Reclast after Forteo. When my second year ended his I only recommendation was that I stay on Forteo. He was quite happy that I was willing to continue the injections. It is likely that extended use of these two drugs will be more usual in two years. But there are newer medications that may also be available.
If I had to take something I might try risedronate and then transition back to Forteo as the second application is said to be "as robust as the first."
I do know one user who has maintained and expanded gains with the use of bioequivalent hormone replacement.
And it looks as though we may have better choices when your Tymlos time has passed.

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How soon after finishing 20 months of Tymlos is it recommended to start next osteoporosis medication?

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Profile picture for md79 @md79

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.

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@md79
Sounds like you are doing well. May I ask how old you are. ? I’m 70. 3 drs refuse HRT for me

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Profile picture for njx58 @njx58

@lightlifts I greatly respect gently 's opinion, and her decisions for her own care, but she is just speculating on the long-term benefits and possible side effects. No offense meant at all, but all she can do is speculate since there are no studies. That's her choice.

I personally would not use Tymlos for more than two years. If it hasn't been studied, I'm not going to make myself the guinea pig. I got great results in the time I took it, and I'm satisfied with that. I'm happy to not be taking it any longer.

P.S. you mentioned your drug plan. You can sometimes get approval for an exception if you've been taking the medication. Most insurers don't expect you to switch drugs mid-stream for something you're taking for just a year or two. Is this a Part D plan or just regular insurance?

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@njx58,
before I accept too much credit--
At 24 month the endocrinologist I see advised me to stay on Forteo. He is one of those brilliant, older osteoporosis-only specialists with a deep understanding of bone morphology who stays abreast of the latest research on osteoporosis.
Only an insurance adjuster avoiding payment would call my treatment experimental. Technically, prescribing an FDA approved medication with a dosing variation different from the OED suggested dosing is not experimental.
So this doctor after looking at ten years of carefully requisitioned labs and bone scans said, "I think you should stay on Forteo." He never did say--or you could take this or that other medication. I never registered the eagerness I felt. I asked calmly, even seeming reluctant, "For how long?"
Some patients refuse to follow professional medical advise. I merely yielded.

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Profile picture for ipg @ipg

@md79
Sounds like you are doing well. May I ask how old you are. ? I’m 70. 3 drs refuse HRT for me

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@ipg Hi, I am 70 y.o. As I mentioned, I had a subtotal hysterectomy at age 34, but a small piece of one of my ovaries did not function. I was on Premarin until age 50. Since July, I have been on a transdermal estradiol patch 0.025 mg.
I hope this information is helpful.

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Profile picture for gently @gently

@njx58,
before I accept too much credit--
At 24 month the endocrinologist I see advised me to stay on Forteo. He is one of those brilliant, older osteoporosis-only specialists with a deep understanding of bone morphology who stays abreast of the latest research on osteoporosis.
Only an insurance adjuster avoiding payment would call my treatment experimental. Technically, prescribing an FDA approved medication with a dosing variation different from the OED suggested dosing is not experimental.
So this doctor after looking at ten years of carefully requisitioned labs and bone scans said, "I think you should stay on Forteo." He never did say--or you could take this or that other medication. I never registered the eagerness I felt. I asked calmly, even seeming reluctant, "For how long?"
Some patients refuse to follow professional medical advise. I merely yielded.

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@gently I hear you.

I repeat that osteoporosis is an unbelievably frustrating condition. It has to be the most poorly treated disease. The face that people have to use forums like this to find out basic things that THEIR DOCTOR DOESN'T TELL THEM is beyond ridiculous. "Here - you figure out what medication to take!" Luckily, there are people like you willing to share information for those fortunate enough to stumble onto this site. 🙂

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