1. < Osteoporosis & Bone Health
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Dr recommending fosamax after serious wrist fracture .

Posted by bridget11 @bridget11, Apr 5 10:25pm

64 yr old female with recent t-score of -1.8 (have actually been at that number for 6 years) I fell really hard while running down hill relatively fast and broke my wrist on Feb 13. 2 plates and 14 screws later I am still recovering. The surgeon indicated my bone was soft and he felt if was a fragility fracture.. I guess because of what it looked like and how bad it was. So my PCP thinks I should start Fosamax now. I prefer to focus more on heavy strength training and plyos which I have been doing but can do more. Should I find a doctor that is more experienced in this area to help me navigate this issue? I am also small - 5'2" 97 lbs so my bones are small. Thanks for any input on this.

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bridget11 | @bridget11 | Apr 6 3:55pm
In reply to @njx58 "In my experience with both myself and with my wife, a PCP is not the right..." + (show)
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In my experience with both myself and with my wife, a PCP is not the right person to treat osteoporosis. Most of them prescribe Fosamax because it's the oldest medication and that's all they know about. I recommend finding an endocrinologist who is experienced with osteoporosis. Honestly, even my wife's first endocrinologist was no good. 😉

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@njx58 Thank you! This seems like best option at this time and hopefully find a good one! I have access to good medical facilities so that should help.

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bridget11 | @bridget11 | Apr 6 4:00pm
In reply to @bswpb "I tried all the oral medications after I went through early menopause and they gave me..." + (show)
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I tried all the oral medications after I went through early menopause and they gave me horrible GERD. Then I broke my left wrist. Was able to have an external fixator so no plates. I did Forteo for 16 months and had great results. I had one Reclast infusion and had horrible jaw pain. Refused further treatment at that point and my bone density stayed stable for osteopenia for about 15 years maybe a little longer. I started Prolia last year because I have had multiple fractures and really don’t want more! I don’t know if you get better results with anabolic medications but if your insurance will allow one of those I would got for that! I would also find a good rheumatologist or endocrinologist before making the decision.

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@bswpb Thank you!. I was wondering about the anabolic medications but not sure if my insurance would cover them at this point. My sister did take them but she has bad t scores and lots of fractures also. Sorry to hear about all your fractures. This wrist has been horrible. There were so many breaks in it and both bones were fractured so I wanted the plates in there! I am going to find a specialist for sure.

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bridget11 | @bridget11 | Apr 6 4:05pm
In reply to @oopsiedaisy "Have you had a DEXA scan? No medications should be started, in my opinion, until you've..." + (show)
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Have you had a DEXA scan? No medications should be started, in my opinion, until you've had a scan to establish you baseline T-score. Starting an anti-resorptive may not be the best option for you if you have severe osteoporosis (T-score of less than -2.5 and/or a fracture). The latest protocols recommend starting on an anabolic (bone building) medication first, not an anti-resorptive like Fosamax.

I agree with others who have recommended finding an endocrinologist who treats metabolic bone diseases like osteoporosis before starting any medication.

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@oopsiedaisy Yes I had my first one 10 yrs ago at age 54 due to family history. I have had several since then -1.8 for the past 6 years. They are only recommending meds due to the surgeon saying the bone was soft. Not based on the T -score. I am going to look for a specialist as others have said before starting any meds. Thanks.

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bridget11 | @bridget11 | Apr 6 4:28pm
In reply to @hungrybirder "For what it’s worth, I’m 79, small boned and have shrunk to 5 ft. I see..." + (show)
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For what it’s worth, I’m 79, small boned and have shrunk to 5 ft. I see 2 endocrinologists and have had my forearm scanned at the same time as my spine and hips for the last 2 years. The forearm has a reading of -4.1 and I visualize it snapping every morning when I do my plank routine. Both doctors say that is unlikely but who knows. And both say there is little that current meds can do to built the type of bone in the forearm. Equally depressing, they view the readings for my spine, which are pretty good, as totally worthless due to my scoliosis and the number of bone spurs that are being seen as “bone”. So we are focusing on maintaining stable readings at the hips. Getting older isn’t for wimps!

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@hungrybirder Thanks for your note. I have not had readings on my wrists - I think they just do them in certain cases but next time I have one I will see if they will look at them. I think we are definitely at a disadvantage with our small bones. I agree this getting old stuff is hard!

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bridget11 | @bridget11 | Apr 6 4:33pm
In reply to @nycmusic "Good luck with many docs who don’t offer many options. ENDOs generally prescribe, often without concern..." + (show)
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Good luck with many docs who don’t offer many options. ENDOs generally prescribe, often without concern for side effects..…one alternative is HRT patches which don’t have side effects and should not cause coronary problems in patch form…I’m not a doc, but that has appeal for me, especially considering my own medical issues/history. It’s our personal medical profile that helps determine what the best path is….Wishing you the best….meanwhile,, do what exercises you can, especially balance and resistance…check your diet and consider a really well-researched supplement.

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@nycmusic Thanks for your note. I was also thinking about HRT but the little I read says I missed that window. I will ask about it for sure though. As soon as I'm cleared, I will be back in the gym! For now, I am going to get a good plyo routine going as I can do that as long as I don't fall .....

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bridget11 | @bridget11 | Apr 6 4:38pm
In reply to @dianebroffdodson "Have been on Fosamax for 3+ years & developed osteonecrosis in my jaw. The enlargement has..." + (show)
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Have been on Fosamax for 3+ years & developed osteonecrosis in my jaw.
The enlargement has stretched my gums in the area so it has split open. Also began to have severe stomach issues. Had some improvement in bone density but not worth the side effects.

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@dianebroffdodson Thanks for your note. Sorry to hear that! That is the side effect that most scares me. I train for marathons and I really don't want to deal with any side effects to be honest! Although I'm sure no one wants side effects. 3 of my sisters are taking Fosamax and so far have been free of side effects. But I think it has only been a year or so.

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nycmusic | @nycmusic | Apr 6 5:43pm
In reply to @bridget11 "@nycmusic Thanks for your note. I was also thinking about HRT but the little I read..." + (show)
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@nycmusic Thanks for your note. I was also thinking about HRT but the little I read says I missed that window. I will ask about it for sure though. As soon as I'm cleared, I will be back in the gym! For now, I am going to get a good plyo routine going as I can do that as long as I don't fall .....

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@bridget11 I don’t think that window is the same as it used to be…anyone got clear info ?

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oopsiedaisy | @oopsiedaisy | Apr 6 6:59pm
In reply to @bridget11 "@oopsiedaisy Yes I had my first one 10 yrs ago at age 54 due to family..." + (show)
Profile picture for bridget11 @bridget11

@oopsiedaisy Yes I had my first one 10 yrs ago at age 54 due to family history. I have had several since then -1.8 for the past 6 years. They are only recommending meds due to the surgeon saying the bone was soft. Not based on the T -score. I am going to look for a specialist as others have said before starting any meds. Thanks.

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@bridget11 There are underlying diseases that can make your bones soft. Someone here recently was diagnosed with hypophosphatasia (HPP). This is a genetic disease which is confirmed using genetic testing. I’m mentioning it because of your surgeon’s comment on your bones being soft. Bisphosphonates like Fosamax are contraindicated for people with HPP and can make the disease worse.

This is why it’s important to see a well-informed endocrinologist. I started seeing one last year and found out that I have a condition which worsens osteoporosis (idiopathic hypercalciuria). No one ever did full testing on me before her and I’ve had osteopenia/porosis for 12 years.

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daisy17 | @daisy17 | Apr 6 7:29pm

Your DEXA score is not even within the osteoporosis starting point of -2.5. My scores are much worse than that (-2.7 at hips and -4.1 in spine) and I have refused any bone meds thus far (no fractures to date).

Like you, my doctor recommended Fosamax (I can't take Tymlos or Forteo due to parathyroid issues). I have decided not to take it based on articles I read that said it offers minimal fracture prevention benefits in postmenopausal women without a prior fracture or vertebral compression. It does make your DEXA numbers better because you retain old bone. The only reason I'd consider a bone drug was if it offered considerable fracture prevention, because isn't that the reason for taking a medication?

There are many articles about studies done on this, here is one: https://www.amjmed.com/article/S0002-9343(24)00101-3/fulltext
The last paragraph offers a summary of findings: "for patients with osteoporosis based on bone density alone, treatment benefits are less certain. Hip fracture risk reduction is modest and not supported in patients without a history of fracture. Reductions in vertebral fractures are substantial regardless of baseline risk, but whether these reductions correspond to less chronic pain and disability is unclear. Clinical evidence is weaker for newer agents. Future guidelines and reviews on osteoporosis treatment should clearly distinguish between primary and secondary prevention of fractures to best inform clinical decision-making. Despite guideline recommendations and calls for more screening and treatment, there are legitimate reasons for some clinicians and patients to opt out."

Another article by Consumer Reports: https://www.consumerreports.org/cro/2012/04/popular-osteoporosis-drugs-come-with-mounting-concerns/index.htm
From this article: "Bottom line. Bisphosphonates offer only modest benefits in building bone and preventing fractures, and that should be considered along with the risks."

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