1. < Osteoporosis & Bone Health

Improve bone density and strength without medication?

Posted by plav @plav, Dec 20, 2023

Any luck improving bone density and strength without medication? It seems the medications only mildly help ... and they only help some patients; some studies show the slight improvement in density does not mean quality bone was built. I'm not comfortable with moving forward with the treatments just because "that's what we give patients with osteoporosis". There seems to be no room for education or discussion, or research into actual results or other options.

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lynn59 | @lynn59 | Dec 23, 2023
In reply to @sallyj2 "66. Age since menopause is difficult to determine. Had hysterectomy 13 years ago, but kept an..." + (show)
@sallyj2

66. Age since menopause is difficult to determine. Had hysterectomy 13 years ago, but kept an ovary until four years ago. Ovary was definitely working until five years ago. Hope that helps.

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Thanks for sharing. Did you start at 66?

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1 reply
teb | @teb | Dec 23, 2023
In reply to @lynn59 "Hi Teb, you and I have had the conversation about HRT before, and I found your..." + (show)
@lynn59

Hi Teb, you and I have had the conversation about HRT before, and I found your comment about starting within 10 years of menopause interesting. I am turning 65 very soon and 17 years out of menopause. My doctor refuses to prescribe it to me, but I found a doctor who would. When I went to fill the prescription this week, the pharmacist said take a pause until after the new year and do more research!! My prescription is for Climara 25 (0.025 mg/24hr patch weekly) and Prometrium (100 mg capsule) daily for 25 days per month. I’m Canadian so I’m not sure the drugs are the same in the US?

I’m in a holding pattern as I can’t get in to see an endocrinologist until May 2024 so I thought this might stabilize me until I can start on a bone building drug. I’d love to hear people’s comments about someone my age and years out of menopause starting on a low dose estrogen patch!!!

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That is the lowest dose of transdermal estrogen patch you can be on. I was on that for years and it did maintain my gains from Forteo. I recently saw an integrative gynecologist and she upped my prescription to .0375. I think she would have liked to raise it to .05 but I was concerned about the possibility of breast tenderness. The .025 dose seems to have worked but I think the small boost is probably a good idea since I'm not on any osteoporosis drugs for the past 5 years. The dose of 100 mg oral progesterone is the standard prescription for uterine protection.

As far as starting HRT well past the time of menopause, it is considered more risky particularly in terms of cardiac/blood clot risk. Risks of cardiac events are most prevalent in the first year and then the risk diminishes according to the research cited in Estrogen Matters by Avrum Bluming. It would be a good idea to know your personal risks before taking HRT. When going off HRT, bone density declines but I don't know if that would happen if you are taking it for such a short duration.

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2 replies
gently | @gently | Dec 23, 2023
In reply to @windyshores "I wonder if the dose difference between Forteo and Tymlos is due to the differences in..." + (show)
@windyshores

I wonder if the dose difference between Forteo and Tymlos is due to the differences in how they work. (see below) Perhaps Forteo is more direct. When they gave me Forteo in the office I had to stay there for 90 minutes because I could barely breathe, I was dizzy and my heart raced. I chose Tymlos ultimately (It was not available when I tried Forteo) because the pen is adjustable. I started at 2 clicks and moved up slowly. There are 8 clicks in a full dose and I had excellent gains on 6-7 clicks.

One piece of info online:
"Forteo is a lab-made version of human parathyroid hormone (PTH) and Tymlos is a version of human parathyroid hormone-protein. These two drugs are both similar to the PTH that your body produces naturally."

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Tymlos has a greater attachment to parathyroid receptors called RG conformation. This attachment leads to rapid and swift increase in intermittant signaling. Forteo binds weakly to RG but more firmly to RO receptor which results in prolonged signaling of cells and prolonged calcemic responses. Intermittant signaling results in greated bone growth. Prolonged signaling supports resorptive action.
One other piece of on line information:
bioavailability of 80mcg Tymlos 36mc
bioavailability of 20mcg Forteo 19mcg
Some really smart person could volunteer to straighten all this out.

I wonder if reduced dose of Tymlos provides a greater percentage of bioavailable abloparatide.
With the RG advantage Tymlos must have a wider anabolic window than Forteo by far.

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1 reply
gently | @gently | Dec 23, 2023
In reply to @windyshores "I wonder if the dose difference between Forteo and Tymlos is due to the differences in..." + (show)
@windyshores

I wonder if the dose difference between Forteo and Tymlos is due to the differences in how they work. (see below) Perhaps Forteo is more direct. When they gave me Forteo in the office I had to stay there for 90 minutes because I could barely breathe, I was dizzy and my heart raced. I chose Tymlos ultimately (It was not available when I tried Forteo) because the pen is adjustable. I started at 2 clicks and moved up slowly. There are 8 clicks in a full dose and I had excellent gains on 6-7 clicks.

One piece of info online:
"Forteo is a lab-made version of human parathyroid hormone (PTH) and Tymlos is a version of human parathyroid hormone-protein. These two drugs are both similar to the PTH that your body produces naturally."

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Did you have any testing during that 90 minutes. EKG or blood pressure. Thank goodness you had it in the office. I wonder if it was drug induced hypercalcemia, which could be why the lower clicks were better for you. This clicking business has been of great benefit. I'm always tempted to ventriloquize.

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gently | @gently | Dec 23, 2023
In reply to @sallyj2 "I was looking at Tymlos because I could adjust the dose. I’m super sensitive to meds...." + (show)
@sallyj2

I was looking at Tymlos because I could adjust the dose. I’m super sensitive to meds. My hip density is worse than spine. I think we’re all overprescribed too. I’m also in a hurry given L2 fracture. I didn’t realize Tymlos was stronger! The doctor said I could use either. Thanks everyone!

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"If you take more TYMLOS than prescribed you may have symptoms such as muscle weakness, low energy, headache, nausea, dizziness (especially when getting up after sitting for a while), and a faster heartbeat. "
From the package insert a clue that we might be overprescribed.

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koleke | @koleke | Dec 23, 2023

That's good news! I'll definitely tell him. Thank you so much! Merry Christmas!

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windyshores | @windyshores | Dec 23, 2023
In reply to @gently "Tymlos has a greater attachment to parathyroid receptors called RG conformation. This attachment leads to rapid..." + (show)
@gently


Tymlos has a greater attachment to parathyroid receptors called RG conformation. This attachment leads to rapid and swift increase in intermittant signaling. Forteo binds weakly to RG but more firmly to RO receptor which results in prolonged signaling of cells and prolonged calcemic responses. Intermittant signaling results in greated bone growth. Prolonged signaling supports resorptive action.
One other piece of on line information:
bioavailability of 80mcg Tymlos 36mc
bioavailability of 20mcg Forteo 19mcg
Some really smart person could volunteer to straighten all this out.

I wonder if reduced dose of Tymlos provides a greater percentage of bioavailable abloparatide.
With the RG advantage Tymlos must have a wider anabolic window than Forteo by far.

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@gently great info, very helpful! I do think it is oversimplifying to say Forteo is 1/4 the strength of Tymlos in order to justify two clicks, but I am not knowledgeable enough to figure it out! Your post was really helpful. I guess docs are telling patients that two clicks are enough but it would scare me. Even I, who was in the ER after my first full dose, managed over time to get up to 6 or 7 clicks. The side effects are new with each bump up but then they settle down, in my experience. With your research, what do you think?

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lynn59 | @lynn59 | Dec 23, 2023
In reply to @teb "That is the lowest dose of transdermal estrogen patch you can be on. I was on..." + (show)
@teb

That is the lowest dose of transdermal estrogen patch you can be on. I was on that for years and it did maintain my gains from Forteo. I recently saw an integrative gynecologist and she upped my prescription to .0375. I think she would have liked to raise it to .05 but I was concerned about the possibility of breast tenderness. The .025 dose seems to have worked but I think the small boost is probably a good idea since I'm not on any osteoporosis drugs for the past 5 years. The dose of 100 mg oral progesterone is the standard prescription for uterine protection.

As far as starting HRT well past the time of menopause, it is considered more risky particularly in terms of cardiac/blood clot risk. Risks of cardiac events are most prevalent in the first year and then the risk diminishes according to the research cited in Estrogen Matters by Avrum Bluming. It would be a good idea to know your personal risks before taking HRT. When going off HRT, bone density declines but I don't know if that would happen if you are taking it for such a short duration.

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Hi Teb, thanks for the comments on the dosing and potential risks. I heard exactly the same thing but no one has been able to quantify the increased risks for heart/blood clot problems in woman in their 60s with over a decade past menopause. Does it go from 10 per 10,000 to 30 per 10,000 for example? Have you heard any numbers? I think my pharmacist is going to try to find out more. The doctor who prescribed couldn’t answer that … she just told me what you told me. I have a history of heart disease in my family, but as far as I know I don’t have any issues other than a benign irregular heartbeat. I may have plague in my arteries (hereditary and many many years ago a smoker), but I don’t know for sure as I am very fit at present and pass all the stress tests. I’ll look up Avrum Bluming and see what I can find out from that source!

Thanks again for all your help. Plodding away slowly at a solution.

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2 replies
sallyj2 | @sallyj2 | Dec 23, 2023
In reply to @lynn59 "Thanks for sharing. Did you start at 66?" + (show)
@lynn59

Thanks for sharing. Did you start at 66?

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Yes, I did.

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sallyj2 | @sallyj2 | Dec 23, 2023
In reply to @teb "That is the lowest dose of transdermal estrogen patch you can be on. I was on..." + (show)
@teb

That is the lowest dose of transdermal estrogen patch you can be on. I was on that for years and it did maintain my gains from Forteo. I recently saw an integrative gynecologist and she upped my prescription to .0375. I think she would have liked to raise it to .05 but I was concerned about the possibility of breast tenderness. The .025 dose seems to have worked but I think the small boost is probably a good idea since I'm not on any osteoporosis drugs for the past 5 years. The dose of 100 mg oral progesterone is the standard prescription for uterine protection.

As far as starting HRT well past the time of menopause, it is considered more risky particularly in terms of cardiac/blood clot risk. Risks of cardiac events are most prevalent in the first year and then the risk diminishes according to the research cited in Estrogen Matters by Avrum Bluming. It would be a good idea to know your personal risks before taking HRT. When going off HRT, bone density declines but I don't know if that would happen if you are taking it for such a short duration.

Jump to this post

I did have cardiac tests done before starting hormones and was told they were fine for me to take. Some sixties consider them protective.

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