Is medication really necessary?

You will get a lot of varying opinions on this topic.
I’ll give you my personal opinion based on my experience.
In 2018 I was diagnosed with osteoporosis. I was 58 years old.
After 5 different osteoporosis medications, and debilitating side effects, and 6 pelvic fractures, I decided to start hormone replacement therapy at 65 years old, 15 years past menopause. For me the benefits for my bones outweighs the risks of starting HRT at my age.
I will tell you that while exercise, healthy diet, and certain supplements are good for you and your bones overall, it will not be enough to grow bone. It just doesn’t work that way for the majority of people.
Do all the healthy things because it increases your healthspan, but you will probably need to address the bone loss eventually.
Best of luck.

It's more of a matter of personal choice and how you want to treat osteoporosis. I was diagnosed April 2024. I decided to try to reverse (even a smidgen) or at least maintain my scores through other means instead of meds. I'm not ruling out meds but I decided that this was my plan for the next year or so. I had planned on getting a DEXA this April to see if my lifestyle changes are working but my new endocrinologist suggested waiting 2 years to determine if it's helping or worsening my osteoporosis. I take a multitude of supplements, carefully curated by me after extensive research and made significant dietary changes.

I can't tell what's going on with my bones throughout all this without a DEXA at the moment but I do see other changes which I (and my endocrinologist) find very interesting. My hair was always super thin and had a significant bald spot near my hairline, has now grown a lot of new hair (no more bald spot!). Even my hairstylist asked me where all this new hair is coming from. More significantly (and perhaps more bone related) is the fact that in September I developed a significant vertical crack in my front tooth. In the beginning it wasn't too noticeable and it didn't compromise the tooth. By Thanksgiving, the crack worsened and could be seen clearly in photos. I kept putting off going to the dentist because my schedule was insane last Fall. Then by January I noticed something peculiar. The crack was beginning to slightly fade and has continued to do so. It's now March and there is absolutely no crack at all visible in the tooth. In addition, the lower part of my top teeth which were very transparent have now completely solidified. In other words, my teeth remineralized due to the increased calcium and phosphate in my saliva which is due to the increased supplementation.

For years (decades?) I always battled high cholesterol by eating a Whole Foods/Plant based diet 80-90% of the time. I ate beef only a few times a year and occasionally would eat salmon. I did this to avoid taking a statin and was successful in keeping my cholesterol levels low. The downside: I consumed very little calcium (hello osteoporosis!) and very little animal protein. Now I take calcium supplements (dose dependent on how much dairy I consume daily) and am fanatical about monitoring my protein intake which includes a fair amount animal protein.

If you're interested in trying more natural approaches for osteoporosis, take a look at the Facebook group "Osteoporosis Natural Remedies". Between this Mayo Clinic group and the Facebook group, you will find so much valuable information and support. Also check out Margaret Martin's website "MelioGuide" and of course Dr. Keith McCormick's "Great Bones" which is the most extensive book written on the subject by someone who had osteoporosis himself.

sgmlt2,
I waited until I was osteoporotic, even though it is said that more women fracture in osteopenia.
Factors to weigh are age, as in hormone status; activity: type and level; and balance issues.
Did you get a frax risk and/or TBS reading with the imaging.
Osteopenia with a T score of -2.4 would suggest a close look at the medications.
Most of us have osteoporosis because of hormone loss. If you were beginning peak years of loss 50 to 62 you'd be in advancing danger.
I'm not fond of the way bisphosphonates work, and they are often the drugs we are offered in osteopenia.
If you fracture because of the decision to avoid the medication, the pain and loss of function will be difficult to reconcile.
It is easier to prevent loss than to regain bone.
If you decide to take medication, you still have do all the other things that are considered alternative.

I was diagnosed with osteopenia at age 53. I was already on HRT at the time so I continued with it but added calcium and Vitamin D supplements. My doctor wanted me to see a rheumatologist at the time but my insurer refused to approve the referral.

I was very fit and active at the time, doing boot camp-style exercise with weights, running, jumping jacks, etc. I continued with a DEXA every 2 years that showed progressive bone loss in my left hip every time while my spine remained stable around -1.5. In 2018, I had slipped into osteoporosis in my hip and I was started on oral alendronate and told I would be on it for five years.

I was very complacent about the diagnosis and didn't do a lot of research other than being aware of the risk of esophageal issues when taking the med so I was careful to follow the instructions. I never thought of my osteoporosis diagnosis. My first DEXA after starting alendronate showed improvement in both my spine and my hip so I thought all was well.

I was told I would be taken off alendronate after five years and assumed that meant no more drugs for life - woo hoo!

I'm afraid I was very much in the dark about the disease.

Just after my five year anniversary on alendronate as I was getting ready to schedule an appt with my PCP to ask about coming off it, I had a compression fracture at T8. I didn't even suspect it was a fracture at the time and thought it was a pulled muscle/muscle spasm as I've suffered those from time to time. It took me four months to see the doctor and I was in complete shock when the x-ray report came back.

My lumbar T-score was -1.6.

Clearly, I wasn't completely understanding the disease because how could I have fractured on a medication that was supposed to keep me from that and improve my bone density?

A year in from my diagnosis I have learned so much about this disease but the biggest takeaways are that everyone is different, medication may be necessary, and a holistic approach is required that includes nutrition and exercise, and possibly supplements and medication.

It hasn't been a smooth road for me. The good news is that I haven't fractured again which is very common within the 12 months after your first fracture. I have recovered from the fracture and am very close to my former lifestyle.

The bad news is that I've tried both Tymlos and Forteo but have had side effects that have prevented me from continuing with them. I do have about six months total of anabolic therapy so hopefully that's helped.

The other issue is that because I was on alendronate for so long, the bone building effect of both of those meds may be diminished.

I see an endocrinologist in April for specific guidance on what's next. I would love a non-med approach but I am no longer sure that's possible.

This was long but my point is that there is no right answer to whether meds are required. You are going to have figure that out for yourself with the help of a specialist and your own research. Just be careful about people making claims either way. Good luck!

It is disappointing that we have to find out the sequence that OP meds should be used for ourselves rather than our doctors knowing.

Best of luck to you on your April endo visit. I hope you find a treatment regime that works well for you.

This was so interesting. I have been trying to learn why Dr. McCormick took Fosomax for a year after his two years on Forteo instead of taking Reclast. I read his book and watched his interviews which did not reveal that specific information. Do you happen to know the answer?

Would you please share the side effects you had on Tymlos and Forteo?

Not the usual ones of dizziness, rapid heart rate, and palpitations. I experienced fatigue and insomnia but the worst side effect was terrible constipation and bloating, to the point that even taking laxatives (Miralax) and stool softeners did not alleviate it.

It was so bad that it was distracting me from work and reducing my energy levels and willingness to exercise. I tried three times to make it work and made sure I was very well hydrated while I was on it.

My belly increased three inches in size due to the bloating.

I also had joint pain on round 2. Round 3 wasn't as bad but the side effect mentioned above was enough to get me to stop it again.

Understanding that everyone’s situation is unique, I wanted to share what I consider a hopeful story. I was diagnosed with osteoporosis in 2021 with a single score marginally beyond the standard -2.5. In 2024, three scores were again, marginally out of normal range. Like so many of us, I faced the challenging decision of going on the OP medications or seeking another option. I was determined not to take the meds because of the possible side effects, some more serious than others. I consulted with a functional medicine doctor and we formulated a plan that I was committed to trying for a period of one year, to be followed by another DEXA scan including a trabecular bone score. It included some dietary changes, physical therapy exercises specifically targeting osteoporosis every other day (at home), a weekly chair/fusion yoga class, a different calcium supplement that the doctor felt is better absorbed, and walking three miles a day at a good pace. I just received my test results today and there was no statistically significant change in my bone density. A couple of scores improved slightly and two scores worsened by just 1/10th. My trabecular bone score, which concerns the micro architecture of the bones, was in the normal range. I was thrilled. The personalized program was successful. The effort and changes were well worth it. I will continue to follow the plan for another year at which time, I will retest and reevaluate my situation. Good luck to everyone out there trying to deal with osteoporosis.

Thanks so much. I start Tymlos on Monday and I am so scared. Now even more so.