68 yr. man with -4.9 in L4!

GP's always prescribe bisphosphonates or Prolia first, partly due to insurance policies. With scores like yours, I think (ask your doc) you would better benefit from Tymlos, Forteo or Evenity, which build bone. I am on Tymlos because the dose is adjustable but I am sensitive to meds, so you might be able to handle any of the three. If insurance won't cover, there are patient assistance programs for Tymlos and Forteo and Amgen/Evenity sometimes can help too.

It would seem you need faster, more intense help with bone-builders as opposed to anti-resorptives, which address bone turnover.

Thanks for the advice. I was thinking similarly. I thought my numbers merited more attention to ameliorating the loss of bone than curbing it enough to allow bones to rebuild (by the likes of Fosamax). Prolia worked wonders on my 80+ year old mother-in-law. [I believe the box claimed it is not for men, but I've seen articles that contradict that.]

I've read that a key factor in proper regulating Ca in blood and bone is the conversion of sex hormones to estradiol. I believe that the advanced drugs you mention targets that mechanism. An expert might be able to address this. I am waiting on a consult with an endocrinologist specializing in osteoporosis. At this point, I don't know if my other bones bear comparable degradation of BMD--not included in the scan.

I should stress that I am absolutely symptom-free (if my anxiety regarding my numbers is ignored). None of the usual factors predisposing one to osteoporosis are present. Normal blood, normal Testosterone levels, no GERD, steroid, hormone-ablation medications, no fractures or balance problems, except I am undeniably small-boned for a man. This hardly seems sufficient to explain my conditions. Loss of estrogen can't explain it!

There are no symptoms with osteoporosis- until you fracture. I was doing sword tai chi before I fractured!

Forteo and Tymlos work with the parathyroid pathway and have nothing to do with estradiol.

Evenity is a sclerostin inhibitor. Sclerostin suppresses bone formation. It is both a bone-builder and an anti-resorptive, though anti-resorptive to a lesser degree than Prolia or bisphosphonates.

DEXA's usually do lumbar spine, femur and femur neck, sometimes both sides, sometimes just one side.

Glad you are going to an endocrinologist!

ps the problem with Prolia is that once stopped bone density plummets and fracture risk goes up, I have been told.

Thanks, I've heard that about Prolia, that the risk can be counter-acted by going to a course of bisphosphonates. I'll study those drugs, while I await the endocrinologist to the rescue!

Both hips were included. One femoral neck had osteoporosis, the other was closing in at -2.4. The average was BMD for each hip was. -1.9. When my numbers are so radically different, it makes we wonder whether my wrist bones are more like hips or my vertebrae. As a musician, fractures in wrist and distal bones would be a horrible.

I realize the big O is symptom-free until it's not, but it sometimes it is discovered when one is suffering back pain from stenosis. I am generally pain-free except when I overdue the exercise.

I just checked and my spine numbers are worse than hip and femur neck is worst of all. My report states that femur neck is unreliable to use for assessing change. Not sure why.

I always wonder about the effect of arthritis, bone spurs etc. Supposedly DEXA scores should be higher but what if bone is worn down? I have to ask about this.

One of my kids is in music. I understand! I know some people do get their wrists tested so maybe you could ask the endocrinologist.

Do you remember what your score was when your sword tai chi stabbed your in the back?

I am totally freaked out by my numbers! Since, osteoporosis numbers like mine are not discovered until there is a fracture, I've not seen any numbers like mine scouring the internet, associated or not with low-impact fractures.

I imagine that they will check the PTH and do other scans besides DEXA to determine the relative "health" of my bones.

I am concerned to learn what has precipitated the loss. The answer is easier with women, especially with smaller bones.

Yes, harder for men. When I had a shot of Forteo in the office, there was a man (tall, seemed big boned) who got a shot right after me!

There is info on the Inspire forum on parathyroid issues. I don't really remember but it is possible the standard testing of PTH doesn't always uncover the problem.

I had numbers close to yours. Both femoral necks were -2.5. Lumbar spine was -4.5. My GP put me on Reclast for 2 years. After 2 years on Reclast -2.4 in left hip and -2.5 in right
Lumbar spine -4.1. I have now had 1 year of Prolia. -2.2 in left hip and -2.5 in right. -3.6 in lumbar spine! Previously I had back pain from possible compression fractures. That mostly disappeared about 10 months into Prolia.

@pami I wish you had been able to go on Tymlos, Forteo or Evenity. A score of -3.6 is still very risky. I fractured three lumbar vertebrae at that level, with one unwise movement. (I also have 4 thoracic fractures from a fall, not osteoporotic).