Is Osteoporosis reversible in post menopausal women?

Here is a link to the info https://www.nps.org.au/australian-prescriber/articles/bone-turnover-markers it’s actually an article and I’m not sure if it references the source. This is a link to a study that seems to suggest the amnt of calcium taken comes into play https://pubmed.ncbi.nlm.nih.gov/11833002/

and this study seems to support taking/eating calcium before you exercise, which I started doing after I read the Calton’s book, Rebuild Your Bones, potentially lessens resorption
https://pubmed.ncbi.nlm.nih.gov/35977107/
Yes, I took osteo-meds. From January 2020 to July 2021 (1.5 yrs) I took alendronate. It caused digestive tract issues so I took a 4 month holiday and in November 2021, I had my 1st zoledronic acid infusion. My endocrinologist expected me to have another zoledronic acid infusion in November 2022, but I chose not to have it.

To date, I have not had any major side effects from the infusion. My reason for not having the 2nd infusion is because I’ve come to realize that my endocrinologist isn’t being as thorough as he should be. I’m really unhappy with him. For example, he did not order any tests, not even a 24 hr calcium urine test, prior to prescribing osteo-meds. Because of this, my BTM (bone turnover markers) were not tested and I have no true baseline values.

Instead of the 2nd zoledronic acid infusion, at my request, I had BTM bloodwork exactly 1 year after the 1st infusion. The problem is that bisphosphonates don’t just leave your system after you take them. For prescription drugs, bisphosphonates have a pretty long half-life, so there is a chance that since I’ve taken bisphosphonates it skewed my November 2022 BTM results.

When I saw my endocrinologist in December 2022, I asked him to review my BTM results. His only comment was that my osteocalcin was near the low end. Note, osteocalcin is “interesting” because from what I gather, it can be an indication of both bone formation and resorption. When I got home, I pulled out my BTM pdf (something I rec’d when I signed up for a BTM webinar) and it clearly states that bisphosphonates lower osteocalcin and that hypothyroidism can lower osteocalcin. So, why, if my endocrinologist is “concerned” about my low osteocalcin level, is he prescribing bisphosphonates, and since he treats my hypothyroidism, he should know that that alone could cause my osteocalcin to be lower.
Here is a link to the BTM pdf I mentioned above https://s3.amazonaws.com/Food4HealthyBonesPDFs/FFHB+Blood+Test-Bone+Markers.pdf

I knew that hyperthyroidism causes or speeds up resorption and therefore can cause bone loss. I’ve recently learned that hypothyroidism slows down bone formation and therefore can lead to bone loss. It sounds like these 2 conditions do the same thing but there is a difference especially when it comes to how to treat the bone loss.

Bisphosphonates seem like a good option if bone turnover is excessive or high but for someone whose problem is with bone formation it seems crazy to treat bone loss with a drug that is supposed to slow resorption.

Additionally, bisphosphonates can lead to brittle bones because they slow resorption and that means that old bone that should be sloughed off, isn’t. I’ve recently read that hypothyroidism can cause brittle bones. So coupling hypothyroidism and bisphosphonates doesn’t seem like the best idea.

It sounds like we have very similar concerns, meaning how can we stay in one piece and pain free for the remainder of our time on this planet.

Some points of concern that I factor in are what if I get cancer or in a car wreck. If I take bisphosphonates now and in 10 years I’m diagnosed w/ cancer and have to take cancer meds that destroy bones and they want me to take more zoledronic acid to protect my bones from the cancer meds, will I be able to? Or what if I get in a car wreck and break my jaw, will I suffer with ONJ.

A 65 y.o. friend has been having issues with a tooth and the dentist can’t see what is going on, not even with x-rays (note this person doesn’t have osteoporosis). The dentist’s expert guess is that there is a crack in the tooth. Apparently a crack in a tooth doesn’t necessarily show up on x-rays. My friend is going in to have the tooth removed. Who’s to say this won’t happen to me at some point, and again I think, what about ONJ.

What were your gains on the alendronate? I’m surprised that you lost all the gains. Have you ever had your BTM tested. Maybe you have excessive turnover. Have you been tested for “secondary” causes of osteoporosis?

I’m not sure if you mentioned this or not, but have you been through menopause? and if yes, how long ago? Did you do HRT?

Not sure if I mentioned this in my original post but I went through pre-mature menopause at age 32. I did not do HRT and I’ve been told by several doctors that now it’s too late. However, after hearing about women in England being given HRT even later in life, I decided to ask my new OB/GYN and she is willing to prescribe it. I’m seriously considering starting HRT in the near-ish future.

@leeosteo with scores like that I would think a bone-builder like Tymlos or Forteo, or possibly Evenity, would be the med for you. I did Tymlos since the dose is adjustable and I can follow it with Evenity if needed, but not the other way around, according to my doc.

I have the same scores as you for those lower lumbar scores and I fractured three out of 5 with a simple twisty movement.

@callalloo One of the books I have read about Osteoporosis has said that we start losing bone at around age 40 so I think a baseline DEXA should be done then. My daughter is 40 now so I bought the book for her too and I hope she heeds the advice in it.

I agree about the current crop of drugs available for osteoporosis. I am in a quandary now over what I should take. I was on Tymlos and had excellent gains from it but now I need to go on something else to maintain those gains. Reclast was planned but my transplant team is concerned about that because my immunosuppressants are affecting my kidneys a bit and Reclast will exacerbate that. Reclast has its side effects the other options all seem worse to me. I cannot use an oral medication due to having Barrett's Esophagus. I saw my endocrinologist on Wednesday and she hoping my transplant team will approve a half dose of Reclast.

I don't know why men's doctors do not suggest DXAs but men's bones are generally more substantial than women's so men are less prone to osteoporosis. Maybe the number of men who have osteoporosis is not significant enough for doctors to suggest DXAs so they only suggest it if the man is small-boned or has fractured a bone.
JK

Could you add a picture of the bottle please? Is it the one that says CALCIUM on large letters across the middle. Thank you in advance!

@contentandwell as I have written, I am in the same situation with kidneys. I forget if I told you that my doc is going to start with 1/4 dose Reclast and either do it more frequently or if I tolerate it, do more at the same time. Hydration, premeds, and slow infusion.
I also have serious GERD (GFR 49-53.)
Please let me know what you end up doing!

I have 2 1/2 months left on Tymlos. Did you do 18 months or two years?

Fearfracture. Thank you so much of all the info. The BTM table is very helpful.

I went through menopause 13 years ago and I did not do HRT. Eight years ago I was put on Alendronate for 4 years by my first PCP. No secondary cause tests were considered. I ended up switching to my mother's PCP in a state wide medical group. I was caring for my mother at the time and I wanted to get both of us into a larger medical group. Only test he used was DXA results. He left the medical group and my mother and I moved to the same PCP again. She was very good and put me on a medication holiday (off Alendronate). Six months later she started looking at secondary cause tests at my request (CBC, CMP, Vit D, 24 hr urine, thyroid, NTX, Celiac). Unfortunately, she left on medical leave right before the pandemic hit and never returned. Only the 24 hr urine came back with an issue. NTX was 24 in 2020 (range 26-124). So the results were never analyzed. Fast forward to today, 3.5 yrs later. Yet another PCP who read my 2022 DXA results showing decline from prior DXA 4 years earlier. In our follow up discussion, he immediately moved to meds. He felt no additional tests are going to change the need for meds at this time. I managed to convince him to follow up with Parathyroid test (based on 2020 24 hr urine results) and re-run the NTX test. He wants to put me on Prolia (denosumab) followed by Alendronate. What I don't understand is why my NTX # is now 22 (range 26-124). Isn't that telling me my bone resorption is way down? Yet my DXA results are worse. So I still need a bisphosphonate? I can't seem to get a clear answer here. Does this mean NTX is not a good measure? Should I be asking for CTX (& P1NP test) prior to new meds? I don't know how he is going to determine if Prolia is helping, other than DXA. Why do I want to wait two years for an answer? He's anticipating I could be on Prolia up to 10 years.

My gains on Alendronate were small e.g., spine 3.5 - 3.3. Interesting my spine has stablized at 3.3 (L2 & 3 are 3.7 & 3.9), hip 2.2, femoral neck 2.7, forearm 2.4.

I just feel like I'm on a runaway train and going down a rat hole of meds. Meds that will be used up and will not be able to help me in 10-15 yrs from now. That's why I've been researching and asking my PCP questions. His answer is the same. "No test is going to change the final outcome.. meds are needed now". I understand his point, however, there has to be a compromise somewhere. He's actually a very good doctor. I'm just not comfortable with that answer and it's creating such anxiety for me that I can't sleep or eat. Obviously, not good for me or my bones.

windyshores, did you take bisphosphonates prior to Tymols? and for how long? Are you using an Endocrinologist?

I use an endocrinologist and although I tried Fosamax a long time ago for a few days, I have never really been on anything other than Tymlos.

I tried Forteo a few years ago and has heart and lung issues immediately after the dose in the MD's office. I went to an immunologist to try to get desensitized.

Thank heavens for Tymlos with its adjustable dose!

Are you seeing an endocriologist? Are you going to ask about Tymlos or Forteo? They work better with less time on bisphosphonates or Prolia, I have been told.

Is the attached picture the one you have mentioned? Just want to make sure I'm ordering the right one.

Peak bone is between 25-30. Generally, women experience a sharp increase in bone loss in the years around menopause (both peri menopause and post menopause). I told my niece that she should get a DEXA when she is 30 so she has a “true” baseline.
I went through early menopause (32). My doctors failed me because they waited until I was 50 to tell me to get a DEXA. Medical professionals are great at things “fixing” somethings like if you need an appendectomy but they stink at preventative medicine. Had anyone said you need a DEXA even 10 years ago, I wouldn’t be in the boat I’m in now, and I was following the pathetic advice they do give: walk, lift light weights, take calcium and vitamin D. If any of those things were enough, my DEXA have reported T-scores on the plus-side. It wasn’t until I’d been diagnosed that I even heard of vitamin K or that you have to lift heavy weights to increase BMD.