1. < Osteoporosis & Bone Health

Mixed results 1 year after Forteo: What are your thoughts?

Posted by mayblin @mayblin, Nov 26, 2023

Hello all,

Recently I've pondering with my dexa results 1 year post Forteo treatment. There are so many involved factors which made it hard to pinpoint whats the main culprit for the negative part of the results.

Background and/Hx: 61yo diagnosed with op summer of 2022, no known fractures. No prior treatment of op including HRT. Started Forteo Sept. 2022. Comorbidities include mild cvd with hyperlipidemia which is controlled with a small dose of crestor; asymptomatic mild GERD w/o treatment and borderline pre-diabetic managed via lifestyle and diet.

At 13 mo post Forteo, Dexa results after vs before treatment are as follows:
L1-L4 spine: avg Tscore -3.1 vs -3.4, with a 4.9% bmd improvement. Each sub level also shows improvements;
Hip: avg Tscore -2.2 vs -1.8, with a -7.6% bmd decreasing!
TBS L1-L4: 1.318 vs 1.264, a 4.3% improvement.
P1NP is elevated in 400+

While I'm very happy with the spine and TBS improvements, the results for the hip/femoral region is very alarming, to say the least.

Has anyone of you experienced or heard of such discrepancy in results that Forteo would produce?

My immediate instinct is that I didn't exercise enough. I was only doing weigh/strength training with free weights consistently, targeting upper, lower and core, 15-20 reps x3-4, twice per week; with some walking and wearing weighted vest/backpack. Never thought about loading hip bones (but, I do quite a bit squats). After some reading I realized maybe I also need to increase amount of quality protein a bit. What's a good protein intake per kg body weight per day, in your opinion?

Anyhow, juggling among drug treatment choices as well as optimal nutrition, supplements and exercise is not an easy task.

Any opinions and suggestions are truly appreciated. The collective experiences and knowledge from patients are powerful!

UPDATE: March 30, 2024

My dexa scan 13 months post forteo therapy was reevaluated later and was found there were technical errors involved. My endo concluded that my femur neck and hip at both sides didn't have any significant change afterall. This is a good news to me. Although I wish I had some positive improvements at femur necks and hips, the results are within expectations. Thanks a lot to those who read my story. mayblin

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

janflute | @janflute | Jan 14 6:23am
In reply to @windyshores "@janflute if you don't have a health condition that concerns your doc about Reclast, they will..." + (show)
@windyshores

@janflute if you don't have a health condition that concerns your doc about Reclast, they will probably suggest kidney testing, then hydration day before, day of and day after, and a slow infusion. You can also medicate beforehand. Many women I know have absolutely no side effects, but many who do have side effects post here. My test dose is because I have afib, kidney disease and med reactions and my doc wants the test dose for those reasons. Not sure your doc will prescribe a test dose without a reason-? My nephrologist is very concerned for my kidneys with Reclast and communicated that to my endo.

I would think that switching to Evenity might be a good possibility if the Forteo is truly not working or even making things worse. Is it possible the technician made an error?!

Jump to this post

Thank you so much for this information. What a treasure you are for taking the time to share all your valuable knowledge! I think that the Forteo is working well, but I will not know until April when I have a bone density test. I see Dr. Mannstatd in May.

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mayblin | @mayblin | Jan 17 2:57pm
In reply to @janflute "I will stop Forteo on July 21,2024. At that time I need to have a Reclast..." + (show)
@janflute

I will stop Forteo on July 21,2024. At that time I need to have a Reclast infusion to hold any bone gains in place. My oral surgeon would prefer me to take Fosomax instead of Reclast, because of complications with the jaw bone should I need invasive dental work in the future. Are there any studies comparing the efficacy of Reclast vs Fosomax in holding bone gains after Forteo?

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@janflute i haven’t come across direct comparison of reclast vs fosamax in a clinical study. The impression i have is that reclast is more powerful. If you could tolerate fosamax and jaw bone is a concern, would fosamax be a better choice in your case, since you could stop using it for a while should oral surgery be needed?

In any case, it is said that effects on jaw bone is minimum if one uses 5 years of fosamax max or 3 annual injections of reclast max. Correct me if this is wrong.

I have a similar time table as yours. Need to decide what to do at end of forteo which is early September.

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1 reply
janflute | @janflute | Jan 17 3:38pm
In reply to @mayblin "@janflute i haven’t come across direct comparison of reclast vs fosamax in a clinical study. The..." + (show)
@mayblin

@janflute i haven’t come across direct comparison of reclast vs fosamax in a clinical study. The impression i have is that reclast is more powerful. If you could tolerate fosamax and jaw bone is a concern, would fosamax be a better choice in your case, since you could stop using it for a while should oral surgery be needed?

In any case, it is said that effects on jaw bone is minimum if one uses 5 years of fosamax max or 3 annual injections of reclast max. Correct me if this is wrong.

I have a similar time table as yours. Need to decide what to do at end of forteo which is early September.

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Thank you so much!

REPLY
mayblin | @mayblin | Jan 18 10:11pm
In reply to @windyshores "@mayblin I don't think lack of exercise explains your situation. I hope you will do Forteo..." + (show)
@windyshores

@mayblin I don't think lack of exercise explains your situation. I hope you will do Forteo for two years and have a DEXA then. It is still early to do a DEXA. The loss in your hip is a mystery. What does your doctor say?

For those who are nervous about Reclast, you could ask for a test dose of 20% to see how you react. Then have another infusion at a dose of your choice in 3 months. Again, discuss with a doc!

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@windyshores thank you for your thoughts! I've been reading since my puzzling dexa came out. It did seem that exercise might not help too much with bmd, although we have to do them to get stronger and get a better balance. My doctor didn't offer any explanation, guess the significant bmd decrease in hip/femoral neck puzzled her too. From what I read lately, forteo doesn't help bmd much in the femoral area. And due to the porosity increases in the cortical bones, bmd could decrease. In my case it decreased a lot, although this may not indicate decrease in strength. I sure hope so. If the trend persists, I'd have to cook up another plan with my endo.

Keep us updated with your progress with evenity and reclast. Best of luck to you!

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