Score Threshold for when to consult a specialist

I have never used a primary care doctor for osteoporosis. I have seen both heumatologist and endocrinologist and would recommend an endocrinologist, especially in your situation.

Again, with your spinal scores, it would be good to take a bone-builder. They also improve bone quality, I have been told, so there is a better foundation for anti-resorptives later.

The sequence of drugs has been a topic of discussion, since I and others have read that it is better to take anabolics first: they are more effective before, not after, anti-resorptives.

But insurance wants us to fail other drugs and/or fracture to get approval for bone builders. I am not sure how your insurance works but -4.4 should, in my view anyway, justify anabolics. Your endo would know.

My PCP expressed surprise that I was on Tymlos, and told me that Fosamax is "first line." Luckily I already had an endo and didn't argue it! This is just my experience. As always, ask your doc, hopefully an endo.

When my PCP order me a DEXA I was absolutely incredulous. I thought she mixed up my age. I have to be grateful for her following her hunch that, given my small stature, I might be at risk commensurate with her mostly post-menopausal patients of average stature. [She never put it this way.] I am lucky that I didn't find this out the hard way. I'm glad to find you back up my hunch that anti-resorptives would be ill-advised--as well that an endo would be the best place to find out WTF happened to land me here.

The amount of research I've done has been exhilarating, but it is nearly all statistical/impersonal. I am grateful to connect with you and others here to know better what's out there. [I couldn't even find out how bad my numbers were--I couldn't find any numbers as bad as mine!]

sorry for typo- I meant rheumatologist! Again I found endocrinology most helpful and they might help figure out what is going on for you. Good luck!

Thanks. I knew. I find that "Auto-Spell-check keeps ducking up my instant massages."

@dk68 My situation is very similar to yours re: T-scores and PCP recommendations, endo. I also requested and received a referral to an endocrinologist. I met with her last week and left the appt thinking that it was one of the best decisions I ever made. She recommended an anabolic followed by an antiresorptive to "seal in" the gains. Also, I have found R. Keith McCormick's new book, "Great Bones - Taking Control of Your Osteoporosis", very helpful. It was published last month (Feb 2023) and is available on Amazon or at his website.

Had you any low-impact fractures, before your DEXA (that triggered the scanning)? Your endo seems to be reflecting much of the current (emerging?) treatment protocols. I would think that an endo seeing my numbers would expedite my appt.

I was impressed with the account of bone-remodeling that McCormick gave. I am, however, a little skeptical with his claims regarding that supplements that can reset balance at the micro level when his program of supplements crests $100 a month.

I've taken many of them for years, but added K2 (mk7) and Mg after getting my diagnosis. I renewing my collagen powder with the idea that it will help avoid my bones become brittle.

@dk68 I broke the same wrist twice -- 22 years ago (premenopausal) and 10 years ago (post) while hiking. Although I'm 63, my PCP put in an order for a DEXA, because of my BMI/weight and/or recent celiac diagnosis. I was a bit disappointed when my PCP recommended alendronate or zoledronic acid for my osteoporosis. However, I still consider her gem, especially for having the foresight to order a bone density scan and celiac test last year.

I can't speak to McCormick's supplements because I don't take them. However, between his books and the youtubes he's created or been interviewed on, I find him to be informative, knowledgeable, and thoughtful. I've also added K2 supplementation since my diagnosis but not magnesium (my dietician felt I was getting sufficient magnesium through my diet).

As a musician, I'm freaked out about the possibility of breaking anything in my upper body--especially a wrist. At my age, I would likely be the end of making music. Gem as my PCP might be, she assured me that my wrists were likely to be the same as my lower body SCAN. However, which bones? I have a lumbar vertebra of -4.9, a femoral neck of -2.7 and the rest of the hips are osteopenia. She also proposed for me to spend the next 3 years on Fosamax. For now, I'm staying with her.

I, too, am impressed with McCormick. I'm going to get his book. In the meantime, I tried to add some of the supplements found in his osteo naturals that I thought might be most effective/least risk.