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Mixed results 1 year after Forteo: What are your thoughts?
Osteoporosis & Bone Health | Last Active: Aug 15 2:11pm | Replies (86)Comment receiving replies
@gently Thank you so much for your insights! Quatitative CT sounds interesting, is it used clinically? Your read about Forteo's effects on cortical bones may explain my results, I surely hope so, and wish femoral/hip bmd turns back up at the end of the treatment.
My knowledge of P1NP & CTX are fairly new. My endo didn't check either prior to forteo, she checked P1NP only at 1 year. If they are important, would these be standard tests for everyone at diagnosis, as well as markers for therapeutic progress? That puzzles me. There is an article by Kim et al about forteo, where the authors illustrated the anabolic window of forteo, as well as these 2 bone turnover markers vs time (in month). It appears that the anabolic window is about 24 months, that's when P1NP and CTX reach at an equivalent level. That's interesting. I might ask to get both markers tested when I see her at 18 month. Out of curiosity, why might you consider the 3rd year of forteo? Would the third year help to achieve more bone building even with CTX rising? Or, would sequential bisphosphanate treatment after forteo hinder any future anabolic effectiveness?
The article you attached is a good read. 0.8g/kg/day seems low though, but that's from nutritional experts. I had the impression that elders generally are advised to increase protein intake. The consesus of optimal amount for op patients is hard to figure out.
The high impact exercise to stimulate femoral/hip area can be challenging to some of us. My knees are complaining just after 10 days of hopping n jumping lol....
Replies to "@gently Thank you so much for your insights! Quatitative CT sounds interesting, is it used clinically?..."
Jumping and hopping can slightly displace my kneecap. But it never makes me laugh. You must be very good natured. I can run and skip without trouble.
We share the impression about elders, but it may be more about how much absorption your body can effect. One vexing question is how do you know.
If you look at the mcchanisms of action with bisphosphonates objectively, you'd conclude that a bisphosphonate would "blunt" the effect of Forteo. I have it from a bone expert that alendronate is the bis to use intermittantly because is has the least persistance in the bone. zolendronate (Reclast) is the most persistent in the bone.
While scavenging for ideas, it occurred to me that we need brief periods of osteoclasts. Osteoblasts work most effectively when coupling with osteoclasts. My plan with the bone markers is to follow them until the anabolic window closes and then pause the Forteo. If the CTX or when CTX rises sufficiently or P1NP drops significantly, I'll take either alendronate or Forteo. I'll try to avoid the bisphosphonates because of the type of bone they form.
The very nice curve illustrated by Kim et all might be accurate.
I have it from an endocrinologist that in his long practice the anabolic window in most women drops after three months on Forteo according to the bone markers. While that didn't happen to me or my markers, we may be all quite different from the graph. This being the value of the bone markers.
Neither the bone markers, nor qualitative CT are standard of care or widely used. "Economic feasibility" has a role in adoption of these standards. Both types of measurement are costly and insurers don't like to pay for them.
But to your question about CTX. It isn't as stable as P1NP. Some people say unreliable but it does reflect what is happening with the bone, it is just more variable. Time of day, whether you've eaten or not, whether you've exercised or had a recent fracture affect the CTX results.
I want them both because I'm using them in relation to each other in this way. My CTX reading has increased by 1/3rd, but my P1NP has doubled. I''ll continue with Forteo until CTX reads as a higher percentage increase than P1NP. But this may be an incorrect mcethod.
Your P1NP reading is great and I would say that you wouldn't have been advantaged by having it before treatment. And even that you wouldn't have been advantaged by having a CTX. Clearly Forteo is effective for you. If your P1NP were equivocal, then I'd wish you'd had both bone markers before and after. I get the markers every three months.
It is important and also more interesting to know your source and question the information.
You noticed that the article recommended more protein than the CDC recommends. The author works for the beef and egg industry.
I try take 100 grams of protein a day. Just guessing.
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Hi @mayblin, I've been taking alendronate for a couple of years. My spine went out of osteoporosis to osteopenia, but my hips got a little worse. My PCP was perplexed, but I was on high dosages of prednisone for a year and a half for an autoimmune disorder.
I've increased calcium and animal protein, as I was eating a lot of plant based proteins before. I drink way more milk and make yogurt every week. I do keep intake of saturated fats low.
My doctor suggested I get a mini trampoline, rebounder, to build my hips. I did. It was challenging at first, as my knees ached. I found videos for people of all abilities Rebounding at Earth & Owl and found my technique was poor. I changed it and was able to continue rebounding.
My doctor recommended rebounding 10 minutes a day. She also said it would strengthen my pelvic floor muscles. In a couple of months, it really has. I notice a real difference. I feel lifted, not sagging, down there.
I've also looked up exercises to help with bone density in the hips. Bridges and clamshells are good. Dr. Alyssa Kuhn has an exercise that can be done from a chair, stomping, that also may help and be gentle on the knees. Someone posted it yesterday.
Dr. Loren Fishman has 12 Poses vs Osteoporosis, on YouTube. Participants in his study did increase bone density. His study of selected yoga poses improving bone density is ongoing.
I hope that helps, Teri