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Struggling with making an osteoporosis treatment decision
Osteoporosis & Bone Health | Last Active: Jun 4 11:43pm | Replies (661)Comment receiving replies
Hi Windy Shores,
I am following this post and always read your replies as you know your stuff.
I would greatly value your opinion please.
I was diagnosed at age 50 with osteo. As an active, healthy person who exercised regularly and ate clean I just increased all my bone supplements and waited 7 years.
At that time with the osteo worsening I went on Fosamax for 5 years. (I wish I did a deep dive into all this then but didn't) The first 3 years reduced the osteo from - 2.7s back to 2.4s but then at the 5 year dexa went back to the 2.7s. My bloodwork shows my osteoclast activity is doubling again.
That was almost a year ago and I went into deep dive mode. Of course the endo and all docs want to start me on Evenity followed by Prolia (which I really don't want to do).
We thought perhaps I had a parathyroid issue as my wrist was always worse at -3.5 and my serum CA is always 10.1 or so. After doing a workup with a renown parathryroid surgeon they don't think that is the problem so now back to the original meds option. I do not have fractures.
Because of the elevated CA and low forearm score evenity is the desirable drug vs. Tymlos or Forteo. My question is this:
Since I already did my 5 years of 70mg Alendronate would I be able to do reclast instead of Prolia after Evenity? I have asked my docs and no one answers this simple question.
In your experience do you have any suggestions or can point me to someone. There are limited endos where I live and no one has found one who will discuss options.
Thank you sooo very much. You are always soo helpful to everyone.
Barb
Replies to "Hi Windy Shores, I am following this post and always read your replies as you know..."
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@tmbdefazio interesting that your CA score raised the issue of parathyroid. My calcium is usually 10.1-3 and I don't take that much calcium! But my PTH is always well within normal range. I know it can be more complicated than that but I have other reasons for osteoporosis (cancer meds) so I never pursued. I am glad that docs told you your parathyroid seems okay. (There is some discussion of parathyroid on Inspire...)
Yes you can take Reclast or alendronate after Evenity. Amgen makes both Evenity and Prolia and their website recommends Prolia as a follow up for obvious reasons.
Keith McCormick's book "Great Bones" discusses the transition off Evenity and compares it to the problems getting off Prolia though to a lesser extent. Still, without a follow-up med, bone turnover is worse than before treatment, he says. McCormick writes that either a bisphosphonate or Prolia can be used.
He says to transition "immediately" but I believe that means a month after your last injection but double check that.
I chose Tymlos over Evenity because at the time I had heard I could do Evenity after Tymlos but not the other way around. Now my doc says there is no data for that sequence as yet. Tymlos and Forteo work through the parathyroid so if your doc felt your calcium was high, maybe that is why they are going for Evenity. My calcium is the same as yours and I have not had any problems.
One other thing: I believe you would have to stay on Prolia fairly long term or else transition at some point to Reclast, which is very very tricky in terms of timing. I have been told that with Reclast, I might have an infusion or two and then, with monitoring, take a med break. So I feel that makes Reclast the better option for me.
Good luck!