Mixed results 1 year after Forteo: What are your thoughts?

Quantitive CT might reflect increase in strength in the hip and femur. Bone density and bone strength can be at odds. I have read that Forteo can decrease the density of cortical bone because it makes a bone that is more porous a strength in that it enables hip and femur to be more flexible--more able to negotiate stress without tiny cracks or larger fractures.
Bone markers are elevated in advance of bone density increase, several months in advance. You don't mention CTX. When this marker rises from baseline in greater percentage than P1NP.
0.8 grams of protein per kg of body weight. You can't use more than 25 grams of protein at a sitting. Extra protein intake is stored as (ha, ha) fat. High protein intake may induce trabecular bone loss. https://journals.lww.com/nutritiontodayonline/fulltext/2019/05000/optimizing_dietary_protein_for_lifelong_bone.5.aspx#:~:text=Bone%20mineral%20density%20has%20been,with%20a%20normal%20protein%20diet.
There is some buzz about needing ground reaction force to increase density in femur and hip. Some think walking even with weight doesn't provide enough impact. I'm neutral on this issue. But it's in some of the literature. So you'd need to jog and/or jump.
I was pretty careful not to express an opinion, still I hope someone will object. This is a powerful group.
I would, though, be so happy with the Forteo outcome that I would take it for another year.

@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....

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

Gently, I have been reading and listening to very different perspectives on protein in relation to bone loss and fracture risk than what you are describing. What I have gathered is that:
1. Higher protein intake than the suggested RDA of .8 grams per kilogram of bodyweight is not detrimental to bone density and probably improves it.
2. Higher protein intake is essential for preventing sarcopenia which is a key factor in fracturing due to muscle loss contributing to balance problems and falls and being unable to catch yourself if you do fall.
3. 25 grams of protein in a meal is nowhere near the max that adults can utilize. Donald Layman a noted protein researcher says that somewhere around 30 grams is needed at a meal for skeletal muscle protein synthesis to occur.
4. "Extra protein" is not stored as fat.
5. The paper you link to does not support what you are saying. In fact the thrust of the paper is that it appears more protein is needed especially in older adults for better bone health. The highlighted quote that I see via your link is confusing due to the way it is written. On careful rereading I see the quote means the opposite of what it might appear to mean. Both pieces of the quote do in fact indicate improved bone density with protein levels higher than the usual .8 gm.
6. In the conclusion to the paper you link there is a single sentence that clarifies what the author is saying: "contrary to the longstanding hypothesis, fairly compelling evidence to date suggests that higher intakes of dietary protein do not have any detrimental effect on bone and likely pose a beneficial effect.".

Most of what I've said above is my take on interviews with Donald Layman who seems to be a real expert in the area. It's easy to just search on him and find his website and youtube interviews and so on. Dr. Gabrielle Lyon is an MD who has studied with Layman and emphasizes protein in her practice and her talks are also readily available on the internet.
Hope this is of use.

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Hi @06111945cc,
I purchased a Stamina 36" rebounder from Amazon. It was under $100, and I had to pay shipping. It's quite sturdy, and I wasn't strong enough to assemble it myself.
I think it best for you to consult with your doctor about what exercise is appropriate, given your compression fractures. Margaret Martin, a physical therapist who specializes in osteoporosis also has some videos on exercising with compression fractures. You can Google Margaret Martin Compression Fractures Exercise and probably find them.
Earth and Owl has many videos on YouTube for exercising on the rebounder. Some are high intensity and others are low intensity, adapted to those with varying abilities. Some videos have the instructor, Niki, rebounding with her grandmother. Her grandmother's workouts are low intensity, so maybe your doctor will approve that kind of exercise on the rebounder.
It's possible to get a rebounder with a handlebar. I didn't get one, but for a while I wish I had as I was kind of nervous. I'm better at it now. I took it very slow.
The other exercise to check out is Dr. Loren Fishman's "12 Poses vs Osteoporosis." It's yoga poses specially selected to improve bone density with adaptations for osteoporosis, and no injuries throughout the course of the study.
I hope this helps!

I may be misreading but didn't your hip improve from (before) -2.2 to (after) -1.8 is an improvement, right?

Sorry this comment was meant for: mayblin @mayblin, 3 days ago

@vkmov I am very sorry about the confusion. It was too late to edit when I realized my mistakes in that sentence, which should read "at 13 mo post Forteo, Dexa results AFTER vs BEFORE treatment as follows:", not the other way around.

So basically my Lspine and TBS had nice improvements, while hip/femoral neck worsened. That's a puzzle I'm trying to figure out right now.

Hi @vkmov fyi I asked site staff, who kindly corrected the sentence preceding the Dexa results in original post this afternoon. Hope I don’t confuse you further!

Essentially my avg hip/femoral Tscore worsened from 1.8 (pre treatment) to 2.2 (after treatment), bmd decreased 7.6% 🙁, while Lspine and TBS improved nicely.

If you have any insights to this perplex overall results, please share. Thank you!

I believe if you catch an error quickly enough, you can correct it yourself. Try clicking on the 3 dots at the bottom right of your post. I will try it once I hit "post".

Yep, editing is allowed. I have no idea for how long.

An edit after 12 minutes.

Looks like we may be able to edit possubly until the next post in the thread.