Struggling with making an osteoporosis treatment decision
I am just struggling to make a decision about my treatment. I had my first bone density test and found I have osteoporosis. I have a couple of -3.2 vertebrae. My hip bones less problematic. I'm 60, active and fit. I've seen an endocrinologist and a rheumatologist who were both highly recommended. Both said "Evenity" before I barely sat down. But there is so little known about Evenity, and nothing known about its long term effectiveness or risk. I've read heart breaking posts from women who were advised to take Prolia with the same assurance and then had multiple debilitating fractures because so little was known/admitted about rebound risk. I am tearful and anxious and sleepless. I've been so healthy my body has carried me through so much life and adventure. I just don't know what to do , whether I'm putting me/my body at risk. Both doctors are paid consultants for Amgen. I feel hopeless and distressed. One of the doctors, although I said I wanted to consider my options, went ahead and got pre authorization for Evenity from my insurance "to show me how easy it would be". I feel cornered. My general doctor also has concerns about me being put on a relatively unknown drug when I haven't tried something like Forteo with a long track record.
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I'm sure that works well for those with the proper setup.
Your info is very timely to me since I’m scheduled for a infusion with Reclast in a few days. Was told 2 years ago I had osteopenia but didn’t do much about it. Have always been active but not good about calcium. Now that I’ve been on prednisone for PMR last month, rheumatologist says I must have but concerned. He just said options were to take pills that hurt esophagus every morning or these yearly injections. I’m going to look into the Evenity and see if that’s better choice. I’m little distrustful since he hasn’t even said have the DEXA scan before getting the infusion to see where I am before submitting me to infusion. Reclast can do issues with TMJ and have more dental problems which is something I don’t need. Thanks for info and anymore info you can pass on to me.
You really should have a Dexascan to set your baseline. Otherwise, how do you know where you are starting from in order to measure improvement?
Exactly. That seems like a logical way to go about this. Just concerned about how urgent it is to get infusion so fast since I’ve been on prednisone for a month. I’m thinking I’ll be good to wait for few more weeks but have a message into my rheumatologist to see what he answers. Thanks
@zaa Now is a good time to advocate for yourself. Just tell/explain to your doctor that you want/need the DEXA scan before you get treatment. You want to know what you’re dealing with! I’m taking the ‘pills that hurt your esophagus every morning’. For me they have never been a problem. I take the pill once a week with a whole glass of water and stay upright.
If you’re feeling distrustful, can you find a new doctor?
Been looking for new rheumatologist within my health system. Also I was thinking about getting a endocrinologist involved since some of them are experts on osteoporosis. I canceled the reclast for now for more time to study up on my options and read more. Have you seen much improvement on your DEXA scans using the pill? Good to know you only take the pill once a week for it sounded like I had to do this every day. I have dental issues that I’m worried about going forward that complicates this whole thing. Really thank you for your info.
Hi @zaa, I was just diagnosed with osteoporosis after I got a DEXA scan because I'm on prednisone for GCA. My T-score was - 3.1. My doctor prescribed alendronate, 70 mg., once a week. I've taken three doses so far. No problems with my esophagus or any other side effects. I know several other women who took it for years with no problems. Hope that helps.
Yes, it is helpful to hear others comment on what they are using. Did your doctor say this alendronate will be as effective in building bones as any other drug? BTW, I thought I had GCA and had the temporal biopsies done? Did you? I think that was another push in wrong direction by my rheumatologist that was unnecessary although I seemed to be having the sore scalp issues that is seen in GCA. Thanks for your info…it helps to chat with others.
Hi @zaa. My doctor didn't say, but I trust him and it was his drug of choice. Another doctor I trust also recommended it. I think if a drug has been around a while and is effective, some doctors prefer to go with it vs. push the new drugs, which may not have a track record. Usually, after five years on alendronate, or a similar drug, a "drug holiday" is recommended. I'm hoping to get back some bone density - with exercise and supplementation - to be able to get off it before then.
The temporal artery biopsy is pretty much the state of the art tool for diagnosing GCA. I had it done at the end of May. There is also an imaging technique, but it's pretty rare. GCA can result in stroke or blindness so it's nothing to mess with. I think if there's any hint of GCA it's prudent to have the biopsy done. I'm glad I had it done before the Delta variant started gaining ground here.
It sounds like the result of your biopsy was negative. Is that so?
Unfortunately, my DEXA scans did not get better. Probably because I’m still on the prednisone. I’m tapering off now but i was on 20mgs a day until January. I would definitely recommend getting an endocrinologist ! I have an appointment the end of August to discuss all the things I’ve read about on here. I’m also going to ask about a physical therapist who specializes in osteoporosis so i can care for my bones better.
The dental issues from these drugs are rare according to my endocrinologist. He recommends that i get my dentist to carefully follow my jaw health.
What worries you the most?