Struggling with making an osteoporosis treatment decision

Posted by heyhey @heyhey, Dec 15, 2020

I am just struggling to make a decision about my treatment. I had my first bone density test and found I have osteoporosis. I have a couple of -3.2 vertebrae. My hip bones less problematic. I'm 60, active and fit. I've seen an endocrinologist and a rheumatologist who were both highly recommended. Both said "Evenity" before I barely sat down. But there is so little known about Evenity, and nothing known about its long term effectiveness or risk. I've read heart breaking posts from women who were advised to take Prolia with the same assurance and then had multiple debilitating fractures because so little was known/admitted about rebound risk. I am tearful and anxious and sleepless. I've been so healthy my body has carried me through so much life and adventure. I just don't know what to do , whether I'm putting me/my body at risk. Both doctors are paid consultants for Amgen. I feel hopeless and distressed. One of the doctors, although I said I wanted to consider my options, went ahead and got pre authorization for Evenity from my insurance "to show me how easy it would be". I feel cornered. My general doctor also has concerns about me being put on a relatively unknown drug when I haven't tried something like Forteo with a long track record.

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@tsc

Hi @zaa. My doctor didn't say, but I trust him and it was his drug of choice. Another doctor I trust also recommended it. I think if a drug has been around a while and is effective, some doctors prefer to go with it vs. push the new drugs, which may not have a track record. Usually, after five years on alendronate, or a similar drug, a "drug holiday" is recommended. I'm hoping to get back some bone density - with exercise and supplementation - to be able to get off it before then.

The temporal artery biopsy is pretty much the state of the art tool for diagnosing GCA. I had it done at the end of May. There is also an imaging technique, but it's pretty rare. GCA can result in stroke or blindness so it's nothing to mess with. I think if there's any hint of GCA it's prudent to have the biopsy done. I'm glad I had it done before the Delta variant started gaining ground here.

It sounds like the result of your biopsy was negative. Is that so?

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Yes, both sides came out negative but there’s still chance. For now, diagnosis is PMR. Like the idea of a drug holiday!

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@becsbuddy

Unfortunately, my DEXA scans did not get better. Probably because I’m still on the prednisone. I’m tapering off now but i was on 20mgs a day until January. I would definitely recommend getting an endocrinologist ! I have an appointment the end of August to discuss all the things I’ve read about on here. I’m also going to ask about a physical therapist who specializes in osteoporosis so i can care for my bones better.
The dental issues from these drugs are rare according to my endocrinologist. He recommends that i get my dentist to carefully follow my jaw health.
What worries you the most?

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I’ve had TMJ for years and wear night guard due to grinding my teeth. My CT scan last year shows arthritis in my jaw. I had a rare internal resorption on bottom front tooth and it was removed just before I was diagnosed with PMR. So no implant for me, just empty and really worried over time, the teeth can shift backwards and be totally useless, not to mention pretty darn ugly. Jaw bone may never be able to accept implant but, so far, I can’t get answer. I’m still trying to figure out someone who can answer questions on this and have dentist appointment tomorrow but they are not TMJ jaw health experts. Perhaps I should do some digging into that too.

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@tsc

Hi @zaa. My doctor didn't say, but I trust him and it was his drug of choice. Another doctor I trust also recommended it. I think if a drug has been around a while and is effective, some doctors prefer to go with it vs. push the new drugs, which may not have a track record. Usually, after five years on alendronate, or a similar drug, a "drug holiday" is recommended. I'm hoping to get back some bone density - with exercise and supplementation - to be able to get off it before then.

The temporal artery biopsy is pretty much the state of the art tool for diagnosing GCA. I had it done at the end of May. There is also an imaging technique, but it's pretty rare. GCA can result in stroke or blindness so it's nothing to mess with. I think if there's any hint of GCA it's prudent to have the biopsy done. I'm glad I had it done before the Delta variant started gaining ground here.

It sounds like the result of your biopsy was negative. Is that so?

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With a-3.1 I would do Forteo, Tymlos or Evenity. Those stronger drugs won't work as well after taking alendronate. Too many docs start with these "front line" drugs. Trusting doctors feels good but honestly, in every medical situation, whether osteoporosis or cancer, I have benefited from both a second opinion and self-advocacy.

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@windyshores

With a-3.1 I would do Forteo, Tymlos or Evenity. Those stronger drugs won't work as well after taking alendronate. Too many docs start with these "front line" drugs. Trusting doctors feels good but honestly, in every medical situation, whether osteoporosis or cancer, I have benefited from both a second opinion and self-advocacy.

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Thank you for the suggestions, windyshores.

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@zaa

I’ve had TMJ for years and wear night guard due to grinding my teeth. My CT scan last year shows arthritis in my jaw. I had a rare internal resorption on bottom front tooth and it was removed just before I was diagnosed with PMR. So no implant for me, just empty and really worried over time, the teeth can shift backwards and be totally useless, not to mention pretty darn ugly. Jaw bone may never be able to accept implant but, so far, I can’t get answer. I’m still trying to figure out someone who can answer questions on this and have dentist appointment tomorrow but they are not TMJ jaw health experts. Perhaps I should do some digging into that too.

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@zaa How did your dental appointment go? Can this dentist refer you to a TMJ specialist?

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My dentist was on vacation so saw another in office that was NOT helpful. On my list to search for new dentist with experience in my areas. Seems to be very difficult to get dentist/doctor appointments. Just trying to get into general practitioner is out 5 weeks and really isn’t something I should be waiting on. I think people are ending up in emergency rooms due to long wait times to see someone.

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@zaa

My dentist was on vacation so saw another in office that was NOT helpful. On my list to search for new dentist with experience in my areas. Seems to be very difficult to get dentist/doctor appointments. Just trying to get into general practitioner is out 5 weeks and really isn’t something I should be waiting on. I think people are ending up in emergency rooms due to long wait times to see someone.

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@zaa I’ve heard that dental offices are so crowded because no one went these last 18 months. So now their all playing catchup. Have you tried ‘googling’ TMJ specialist to see if there is one near you? Good luck in your search

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Is Forteo and Evenity two different drugs? My understanding is that Forteo is a daily injection that you do for two years.

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Ok, Made a decision to go with Prolia vs Evenity and will begin in Oct. On one hand, I’m uncomfortable because my understanding is Prolia indirectly builds bone by suppressing the natural bone-sloughing of old cells, and Evenity allows the natural process of building/sloughing to continue. I like that. On the other hand, I’m less uncomfortable because a specialty pharmacist and two doctors have all told me their negative experiences with Prolia have been minimal. That was heartening, and that impacted my decision. I received approvals from Medicare and my backup insurer for Prolia but not what my final cost will be. I alerted my dentist at my recent appointment and they did bone measurements to begin tracking for that possible side effect. So I guess this will be it. 😳 Hopefully I won’t experience the horror story of side effects. I wish nobody had to!

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@chocoholic

Ok, Made a decision to go with Prolia vs Evenity and will begin in Oct. On one hand, I’m uncomfortable because my understanding is Prolia indirectly builds bone by suppressing the natural bone-sloughing of old cells, and Evenity allows the natural process of building/sloughing to continue. I like that. On the other hand, I’m less uncomfortable because a specialty pharmacist and two doctors have all told me their negative experiences with Prolia have been minimal. That was heartening, and that impacted my decision. I received approvals from Medicare and my backup insurer for Prolia but not what my final cost will be. I alerted my dentist at my recent appointment and they did bone measurements to begin tracking for that possible side effect. So I guess this will be it. 😳 Hopefully I won’t experience the horror story of side effects. I wish nobody had to!

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Did you consider Tymlos or Forteo? I cannot find your original posts. I don't know what your DEXA scores are. But the use of Prolia can make bone-building drugs less effective and once you go off Prolia you may need to go on them anyway, due to the abrupt drop off in bone density once off Prolia. So it might be better to do bone-building drugs like Tymlos, Forteo or Evenity first. But again I don't know your scores or if you have fractures.

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