Anyone progress from osteoporosis to osteopenia?

At age 68 after years of slowly dropping DEXA numbers I finally agreed to take oral alendronate, a bisphosphonate. I had dropped into osteoporosis in one hip at -2.9, all other number were close but still labeled osteopenia.
Oral alendronate bothered my stomach, and after 7 weeks, I stopped. I was switched to Reclast, a biphosphonate infusion.
After the first Reclast infusion my DEXA score increased 6% in my spine. I’ve since had a second annual infusion. Generally it’s given in a series of 3. I’m going to ask if my third infusion can be done 2 years after the last, as Reclast is supposed to maintain density at high level for 2 years.

Reclast does not build bone. It stops the turnover of bone, the normal cycle of bone maintenance. Bone normally loses some cells and creates new bone to make up for it. Reclast reduces the loss of bone, and the DEXA score goes up. There are other bone meds, anabolic steroids, that actually build bone. An endocrinologist can help guide you through which might be best for you.
All of these drugs have side effects. I’ve had very little with Reclast.

You’ll find a lot of helpful info from others on this site. Each of us have different medical histories that affect decisions on meds.

I went from severe to borderline on Tymlos.

If osteoporosis is milder (above -3.0??) I would get a copy of Keith McCormick's book "Great Bones," It is encyclopedic and covers both holistic approaches and medications very thoroughly.

Thank you for sharing. I also was on alendronate for about three years and developed stomach ulcers. I've had my third Reclast last month. After the first my scores were worse by 3%, after the second, 6%. I'm hoping this changes. Are you doing anything else-certain exercises, diet, calcium supplements. You must be so elated that you're going in the right direction!

I just ordered the book. Thank you. I will ask my doctor about Tymlos.

My lumbar T-scores improved on alendronate. I was barely osteoporotic in 2018 then returned to the osteopenia range after two years, along with weight training, HRT, and supplements (calcium, Vitamin D). My hips never improved but did not deteriorate further, remaining between -2.8 and -3.0.

However, I still experienced a decompression fracture at T8 about a year ago when I placed a tremendous load on my spine by flexing it to place my head under the tap of a large bathtub to rinse my hair. I recall pushing down very hard on my rib cage in order to force my head to reach. I had no idea what happened at the time and went 3 months before seeing my doctor.

I am on an anabolic now (Tymlos, now moving to Forteo) so we'll see if I can improve my bone density.

The one main contributor to increasing bone density, besides Reclast, is probably that I’m taking tamoxifen which is known to be bone protective in postmenopausal women. Evidently the reason is the positive estrogenic response it provides through the body, while blocking estrogen receptors in the breast. I am 2 years post breast cancer surgery.

I tried lifestyle changes before starting alendronate. I increased exercise, weight bearing exercise, and eating enough food high in calcium. Calcium supplements irritate my stomach. None of this stopped the bone loss progression.

I believe estrogen has a highest positive impact on bone health. But I cannot use it because of breast cancer, and family history.

The MD Anderson rheumatologist says the increase in bone density was due to the Reclast. He would like me to continue on it as it also reduces the incidence of bone metastasis. He is happy with my calcium numbers and said just keep doing what I’m doing (eating high calcium foods) if I don’t want to take supplements.

I also see a local endocrinologist who actually orders the Reclast, she has not said much about what is driving the bone density increase (Reclast, tamoxifen, or combo). But it’s a question I’m going to discuss with her because if I only will receive 3 infusions it seems to me pushing the last one out a bit will extend protection.

I have been following the Mediterranean diet, and started adhering to it much more closely since the cancer diagnosis.

Hi debbik,
Welcome to the club, I guess — though none of us really want to be here!
I have posted here before, but here goes anyway. Like you, my DEXA numbers were steadily declining. I chose to stick my head in the sand. With so many other health issues going on, it seemed to be the easiest thing to do. Then at age 68, I had a whopping 8.8% decrease in my Spinal T-score: -3.0! Full blown osteopenia in the Femoral neck: -2.2, and -2.0 in the Total hip. Wake up call!
My rheumatologist was pushing the medical model, the OP drugs. Kind of rolled his eyes when I said let me try a more natural way first. The side effects of the drugs frankly scared me, although if all else failed, I would have gone that route.
From that point on, I dedicated myself to turning this around. That meant structured exercise, 5 sessions a week: strength training, weight bearing, resistance bands, balance, coordination. (Mind you, nothing too heavy. I started with 1 pound weights. Still only up to 3 pounders!) Get out in the sunshine, walk. Increase protein intake. Eat the rainbow! Bioidentical hormones. Supplements galore, things like tocotrienols, collagen, strontium citrate (I know, controversial!), vitamin K2, etc., etc. I bought a low intensity vibration plate (yes, more controversy!), an investment in my health.
My most recent DEXA scan at age 70?
Spine: -0.3 “Normal”(!)
Average Femoral neck: -1.65 “Osteopenia”
Average Total hip: -1.35 “Osteopenia”
My doctor is no longer recommending I begin drug therapy!
So…..it is possible to tackle osteoporosis using alternative methods, and successfully increase your bone density. Not to say that is the only way, but hey, it sure is worth a try.

Hi @triciaot I read from a few articles that the main reason behind the bone mineral density increase by bisphosphonates is due to the decreased bone resorption rate by direct inhibition of osteoclasts. As a result, "While bisphosphonates consistently increase bone mineral density, the change in bone volume, as measured from bone biopsies, is not significant in most studies [160]. The increases bone density is predominantly due to further mineralization of the bone matrix, as more water molecules are replaced by mineral [161]". This excerpt describes short term effects of bisphosphonates.

Tamoxifen ( a SERM) and estrogen are both mild to moderate antiresorptives, although estrogen has many other roles in maintaining bone health. The antiresorptive effects of either estrogen or tamoxifen might be overshadowed by a strong bisphosphonate such as reclast during concomitant use. It will be interesting to hear from your team of doctors regarding the benefits combining a bisphosphonate with tamoxifen. Please keep us updated if you could.

If you’re looking for current outcomes for concurrent use of tamoxifen and biphosphonates I’m sure there is much available as tamoxifen has been used for over 40 years for women with breast cancer, many of whom have low bone density. Tamoxifen is prescribed for me for its anti-cancer properties whether or not it helps my bones. I hope I didn’t indicate that anyone would take tamoxifen for anti-absorptive purposes. A large percentage of women stop tamoxifen due to its side effects and increased risk of DVTs and uterine cancer.

@thisnthat congrats on your progress! Your bones weren't as bad as mine to begin with, that's for sure...I just want to ask if those most recent scores were adjusted by the radiologist due to the strontium Controversy or no controversy, strontium is denser than calcium and replaces it in the bones, so DEXA's do get thrown off. Regardless of that it looks like your program worked. With my scores (after cancer treatment) I could not risk the holistic approach!