Undecided choice of drugs for Osteoporosis

Posted by peace44 @peace44, Oct 10, 2023

I am 80 years old women and have borderline osteoporosis which affects my entire body. My doctor wants me to take Prolia and the Rheumatologist wants me to take Reclast. I’m unhappy with both choices as the side effects are great and I do not tolerate new drugs well. I am very undecided and am considering doing not taking annty drugs for this condition. I have never had a fracture and I’m very active Any opinions or advice.

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@susanfalcon52

I was concerned about the increased risk of stroke and heart attack also. Both my rheumatologist and my endocrinologist wanted me to go on Evenity. So, I went to my cardiologist and he ran some tests. No issues. I went to my neurologist and he ordered an mri of my brain and an ultrasound of the carotid arteries. No blockages. So, I embarked on my Evenity journey. I’m halfway done as I just had sixth injections. No side effects.
I do realize that no one knows what the long term side effects might be.

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So happy to hear you are doing well and no side effects.
Wishing you all the best on your journey.

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You can try the drugs and if you don't like them, stop them. At least the injections won't enter your digestive tract (that is where I am sensitive with medicine).

If you want to try something different, consider checking out Dr. Margaret Gennaro. She does something like telehealth and may have something you'll want to consider.

No matter what you take or don't take, you know that what is important is that you don't fall; and if you are not turning over in bed while you sleep and fracturing your ribs, as my mother-in-law did, you are not yet in severe trouble!

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@peace44

Forgot to add I would prefer taking a natural supplement. I don’t take medication well. I feel I’m to old to take a variety of medicines and I’ve never taken anything for Osteo. Any advise on natural medications.

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Read Dr John Lees books on menopause and osteoporosis.
Yes, he used progesterone cream and with quite success.
However, Success being defined as his patients in his office and others who learned about it and other doctors who have used it in their offices since studying its usage.
This is a natural way and many naturopaths recommend it BUT you must have your hormones tested.
Dr. Lee is no longer living, but many medical practitioners have incorporated progesterone cream for their patients.

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I am being evaluated for Forteo. I am 81, and have had many fractures, but only two recent vertebrae fractures were without trauma. I had an auto accident, was hit by front and side airbags and my car totaled in February 2023. That caused 12 fractures, but PT during the summer caused two vertebral compression fractures. I cannot tolerate the oral meds and did not believe Prolia would be good for me. Happy to find a practitioner who likes Forteo, but might need the adjustable dose of Tymlos.

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The lowest dose of Tymlos 20mcg is the same as the standard dose of Forteo 20mcg. Now, Tymlos is a an excellent drug. The advantage of the adjustable dose is only of value if you want to take more of the drug.
Both are very good choices.
wishing you luck

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There may be another advantage for the financially limited users. Staying at the same dosage level. 20 mcg, a Tymlos pen would last 4 times as long as the Fortro pen.

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Forteo's pen contains 28 doses and Tymlos 30. 4.25 times as long. Ignoring, of course, the expiry 30 days after opening. Tymlos does contain a preservative, though.

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@gently

njhornung,
it would be interesting to know. The studies consider patient compliance and economic feasibility. Individualized medicine is time consuming and expensive. I suspect that part of the problem of adverse reactions is in dosage.
The greatest good for the greatest number is a valuable adage. And pure stastatics are valuable. But we each are just one. I, for one would be willing to save my bones by going to the doctors office monthly every year. (But, not for Evenity) I can easily accept self injections daily for 30 years. Injections quarterly for years and years (but not Prolia). Infusions every six months (but I'd rather not Reclast). Would you balk or comply with the greater effort?
But my thought is that a lower dose of Forteo weekly would work better than the full 120mcg, extending the time for which it continues to increase bone density and strengh, requiring fewer injections over many more years.
Some physicians use the bone markers to encourage compliance by showing the patient the positive effect on the bone that we mostly can't feel.

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My doctor confirmed that Forteo worked as well (maybe better) every other day.

Has anyone else read/heard that?

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If anyone wants to explore lower dosages or change in frequency and encounters the argument that it is not allowed as that would be off-label, there is a one-word reply - Ozempic. Ozempic is a diabetes drug used very profitably off-label for weight loss. During the height of the pandemic, many drugs were tried off-label in the hope of finding something/anything that might help. Chlorohydroxyquin was promoted without proof of efficacy.

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@theofficefan55 I have been told there is no data on Evenity as a follow-up drug. I have also been told, and read, that Tymlos and Forteo don't work well after Prolia. Not sure about Evenity bit the 2.3% improvement in the study cited is not very impressive. In general bone building drugs are less effective after anti-resorptives like Prolia and bisphosphonates. I am so glad you did Forteo before Prolia!

The best transition, according to my doc and McCormick's book "Great Bones" is to Reclast. Fosamax as second choice. However the transition is tricky and according to McCormick, needs to be individualized via CTX blood tests. Docs will tell you 6 months after your last Prolia but ap apparently for some that is too early and the Reclast won't work, and for some that is too late, and bone loss has occurred.

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