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Can you take Forteo again after 5 years of being on no drugs?
I took Forteo for 2 years 5 years ago with some improvement but didn't take any drug afterwards. My dexa results went back to square one.
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HugInterested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.
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@jbfm its a great idea that you have a second course of Forteo, since the lifetime use limitation of 2 years is lifted. The fact that you haven't had any bisphosphonates or prolia after 1st round of forteo may indicate your second round as successful as the first one.
If possible, getting a baseline of bone turnover markers (CTX and P1NP) done before your second course of forteo may be useful. Getting btms monitored during forteo therapy every 3 mo may also be useful, although there are individual variations.
Best luck with your therapy!
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1 Reaction@hopefullibrarian
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362945/" More importantly, the robust anabolic effect of treatment is limited to the first few months of therapy, curtailing the progressive, large increases in bone mass. Perhaps a strategy can be identified whereby patients can experience the anabolic effects of romosozumab on multiple occasions with a limited interval or the use of alternate drugs between courses."
Other studies I emailed to myself! There are probably more on my email....
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8567484/
https://pubmed.ncbi.nlm.nih.gov/32777516/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8085670/
others w/out links
In summary, our studies extend previous studies and reveal novel information on the effects of sclerostin deficiency in bone and sclerostin-depleting treatments on hematopoietic stem cells. Our data indicate that SOST depletion and Sost deficiency not only affects B cell development in the BM relatively early, but also creates an inflammatory bone marrow microenvironment that may become more severe over time. Investigation of the changes in the bone marrow architecture, including alterations in vasculature function and quality, proportions of arterioles and sinusoidal vessels, and local oxygen tension [67,101,102,103], may provide evidence for the specific cell-extrinsic mechanisms that drive the promotion of myelopoiesis in the Sost−/− mice and Scl-Ab-treated mice. In future studies, it would be interesting to investigate the localization of HSC in the Sost−/− bone marrow endosteal and sinusoidal niches, and quantify if specialized niches that promote myeloid differentiation or recruitment are increased [104]. Studies to test possible combinational therapy of Scl-Ab with IL-1 antagonists or TNFα blockade to control myeloid skewing are another potential area of further investigation. The information provided by our studies may be useful in monitoring humans treated with romosozumab for changes in immune cell frequencies, chronic inflammation, and signs of anemia, such that treatments for osteoporosis can be modified to address these hematopoietic changes.
and
Recent findings: Changes in sclerostin levels affect distinct niches within the bone marrow that support hematopoietic stem cells and B cell development. Sclerostin's regulation of adipogenesis could also be important for immune cell maintenance with age. Surprisingly, B cell development in the bone marrow is influenced by Sost produced by mesenchymal stem cells and osteoblasts, but not by osteocytes. Additionally, extramedullary hematopoiesis in the spleen and increased pro-inflammatory cytokine levels in the bone marrow are observed in global Sost-/- mice. In addition to changes in bone marrow density, sclerostin depletion affects B lymphopoiesis and myelopoiesis, as well as other changes within the bone marrow cavity that could affect hematopoiesis. It is therefore important to monitor for hematopoietic changes in patients receiving sclerostin-depleting therapies.
Finally
"The study will investigate if it is possible to maximize the effect of romosozumab by giving it in 2 periods of 6 months interrupted by zoledronate for 12 months compared to romosozumab for 12 months uninterrupted followed by zoledronate for 12 months. The investigators will also evaluate if 6 months of romosozumab followed by 18 months of zoledronate is non-inferior to the standard regimen of romosozumab for 12 months followed by zoledronate for 12 months."
Links (both are about the same study):
https://ctv.veeva.com/study/the-optimised-use-of-romozosumab-study
https://classic.clinicaltrials.gov/ct2/show/NCT06059222
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2 ReactionsThank you for sharing these. I'm glad to see that these studies and trials are happening.
One of my takeaways from the study you linked to on 'Real-world effects and adverse events of romosozumab in Japanese osteoporotic patients: A prospective cohort study', was the timing of the increased BMD of the hip.
The way I understand it, this seems to show that Romosozumab (Evenity) has the greatest impact on the hip in the last 6 months of treatment. I didn't realize this. If this is the case, it might be worth if for me to complete the full 12 consecutive months of treatment rather than breaking it up. I wish we knew more at this point.
Thank you so much for this! I actually had a CTX test last year and I will look up the number. The doctor who read it wrote NORMAL on the results. I'll look up the number and share with my endocrinologist, too. Thank you.
The only problem I have is that my endodontist doesn't want me to take Reclast or Prolia afterwards in case I need a tooth extraction!
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1 Reaction@hopeful librarian thanks for catching that- about the last 6 months of Evenity doing the most for the hip. The question in my mind is, if that is due to anti-resorptive action, does Reclast do the same thing? I am also glad there are studies going on about this question.
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1 ReactionSaved by the endodontist!
Hi windy, with your relative low ctx and evenity's antiresorptive effects, I won't when and if you'd need your reclast. Curious to see your new ctx reading.
That is another question @mayblin. I am assuming the way that Reclast "coats" the bones is the reason it is used to lock in gains, vs the way it lowers CTX, which other drugs do as well. But I am going to ask! However, I can definitely delay Reclast according to my doc. Whenever I stop Evenity which is still kind of uncertain.
You might want to ask your doctor to get a new set of ctx and p1np test before the start of forteo, so you could be monitored during forteo treatment to see if the med is working. Getting a new dexa scan prior to treatment is also a good idea, if you haven't had one recently.
All the best!
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2 ReactionsI have the same problem.