My DEXA scan is -4.6 HRT or Tymlos or both?

Posted by jjjjjjjjjj @jjjjjjjjjj, Sep 19 12:25pm

I’m 62, recovering nicely from a fractured femur./hip replacement. I fell four feet onto concrete and tile. My DEXA scan is -4.6 of spine and -3.6 of femur. Can’t get into the bone clinic until end of November. My primary care supports HRT but said Tymlos should also be considered. I’m weight lifting at the gym and taking all the supplements including whey proteins and creatinine. The meds terrify me but so does the HRT. Any advice greatly appreciated!

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mayblin | @mayblin | Sep 19 1:23pm

With a T-score of -4.6 (LS), -3.6 (FN) and a recent femur/hip fracture, I don’t think HRT alone would be enough for osteoporosis this severe. Ideally, it’s best to discuss the treatment plan with a specialist such as an endocrinologist before starting treatment. They will likely also look carefully for possible secondary causes of osteoporosis.

I’ve always been interested in PTH analog + HRT vs. PTH analog alone, however, there isn’t a clean evidence-based sequence answering that particular question. I myself did a Forteo-to-HRT transition, and a few women on this forum have started Tymlos/Forteo along with HRT.

Given your situation, I would definitely expect an anabolic such as Tymlos to be part of the treatment discussion. The remaining details are probably best worked out with the specialist.

I have a couple of references on PTH analogs + HRT if you’re interested.

gently | @gently | Sep 19 1:53pm

jjjjjjjjj, I like your primary's wisdom. If they order calcium parathyroid and kidney function serum tests. And then order Tymlos, you might be wise to start Tymlos without delay. At 62 you may have secondary cause of osteoporosis which the bone clinic can further investigate at the end of November.
The spine is most concerning. Spinal fracture recovery is never complete. They can't restore the original height of any vertebral compression even with vertebroplasty or spine jack. So with these fractures you lose height, abdominal space impactful for both breathing and digestion. And they are most often painful. Sometimes causing pressure on exiting nerves for your lifetime. Ever more frightening than the medications are the fractures.
No doubt your muscles are stronger than your bone. There is a point in every lift where the mechanical pressure is greatest on the bone. You might reconsider lifting weights until after your spine is stronger spine. -4.6 is risky for fracture.
Tymlos works best in the spine creating strong, integrated, resilient bone.
Your spine specialist may decide in November that you need more immediate protection from Evenity, for example. Then you can just switch.
HRT is best at preventing additional loss of bone, it isn't restorative the way Tymlos is. But taking HRT can provide many other benefits and may slightly enhance the effect of Tymlos
In my lay opinion Tymlos is the best choice for your situation.

gravity3 | @gravity3 | Sep 19 2:37pm

Why are you terrified?

jjjjjjjjjj | @jjjjjjjjjj | Sep 19 2:48pm

In reply to @gravity3 "Why are you terrified?" + (show)

@gravity3
Cancer risks from HRT and possibly being on it the rest of my life.
The Tymlos for side effects. I’m on Atenolol for PVCs and the increased heart rate/dizziness side effects are concerning.

paxbar | @paxbar | Sep 20 11:09am

Your fear is well grounded but assessing for yourself through research what the cost/benefit for the meds really are may help you manage your fear and make the best decision for yourself personally.