Newbie confused by doctor options to choose, including Keith McCormick

Hello Newbie!
Thank you for your great letter. We all have been in your shoes! I chuckle at you getting 'your ducks in a row'.... herding ducks is a great picture for this! We have all had our season of confusion, especially at the beginning when all is so new and strange sounding.... plus navigating through the medical system -- it can be quite a ride!
But have no fear, you have come to the right place for understanding and lots of support. Like many before you, you will learn so much and soon [yes, really,] you will have a better grasp of this whole new world. It can be overwhelming.
You have taken a great step already ... you have an appointment at the Mayo Clinic. Lucky you! I am not in the U.S., so I do feel some envy of your opportunity to get such great input. The endocrinology team is a great choice. They will be able to chart your course. Yes, it is a while - about 3-4 months, but by next year this will be just a memory. And then you will be writing to others on Connect with all of your wisdom to share.
When reading lots of books from different authors, there can be confusion. Perhaps, you could start by making notes, only of your own symptoms, and dates and results from your tests. This is important to have your baseline.
This information will be very important for you to take to your appointment as well. Everyone starts at different levels, with different histories and so each of our treatments are individual.
Please be assured that once you make contact with your medical people at the Mayo Clinic, all will begin to make sense; even the things which seem so muddled now.
Are you making a list of all your questions? Slowly, one by one, each will be answered and all things will become clearer.
You have 'done good' in finding Connect. I have found great information, learning and kind support. Hang in there! Help is on the way !!

My PCP orders bone markers for me though I recently added a second endocrinologist for that purpose because my main doc doesn't use them. McCormick does not manage my osteoporosis but I have seen him for years. I like to collect viewpoints!

If you are starting out, and your bone loss is severe enough to warrant meds, I think your first step is to see an endocrinologist. Maybe get on a waiting list (we recently discussed calling at 10am when cancellations tend to have happened!).

McCormick sees people in person or by phone. It used to be $300 for the first consultation and $85 for the 15 minutes by phone but it has gone up.

You can buy his book "Great Bones." You can also watch videos on YouTube with McCormick. My other favorite is Dr. Ben Leder "Combinations and Sequencing Approaches to Osteoporosis." Others will have suggestions too.

Take your time and learn, ask questions, and things will be clearer. There are only a few options: bisphosphonates or Prolia as antiresorptives, Forteo and Tymlos as bone builders and Evenity as both. It is good to start with Evenity, Tymlos or Forteo and then "lock in" gains with a bisphosphonate. Good luck!

Thank you. You’ve been really helpful answering my newbie questions.

I guess I just need to wait. I’m on the schedule for a “new patient appt” so just have to be patient. I’ll take a huge list of markers with me to request tests for.

Maybe I can get an initial consult with McCormick before my scheduled appts so I’ll have some of the work behind me.

I am currently reading his book and have watched quite a few videos already.

@stacibw my doctor does not do bone marker testing. He told me that there could be an entire conference on this issue. He also said that they don't capture everything going on in bone. (There are other tests besides P1NP and CTX too, like bone specific alkaline phosphatase, PTH and so on).

My bone markers don't match up very well with what is supposed to be happening with medications or with what actually happened (on DEXA) with bone density growth. I just want to insert my own uncertainty here on how much to rely on bone markers . My answer when providers have different perspectives is that they all have a point even if they don't agree!

I have an appointment with Dr. McCormick on 5/15. I can't wait. My endocrinologist was only interested in giving me Fosamax. My primary sided with her. She (endo) never even asked me anything about me. I'm a yoga teacher and have been doing cardo and weights since my early 20's. I am 67. I have been very disillusioned for sure. Overwhelmed. I came across Dr. Mccormick, and I like that he will send you for lots of lab tests if you require them. Nothing even close to the medical profession (from my experience). He has a very good reputation so hoping to start to make progress. I commend you for getting that appointment with Mayo Clinic. Can I ask where you started with them to obtain that appointment or did you just call them? I wish you success in your endeavor and July will be here before you know it! You've made progress already just be getting that appointment!

@stacibw I see an endocrinologist at Mayo Clinic in Rochester, MN. I was referred to endocrinology after a sacral fracture was detected by CT (I get CT scans for cancer surveillance and so the sacral fracture was an incidental finding. The sacral fracture was likely due to pelvic radiation I had for endometrial cancer). I had a referral to endocrinology and it took a few months to get an appointment. The endocrinologist and his team spent an hour with me during my first visit for the assessment. He ordered labs, and a DEXA scan and took a very complete history. When I returned for my next visit a month later he went through the findings and said that I was optimizing everything I could for osteoporosis however the fracture put me into another category altogether. He explained, with a drawing, what osteoporosis is and how medications work on bone. He recommended that I start with 12 months of Evenity. He told me that Evenity "builds bone" and I agreed to do that and so I've had 6 months of the injections. After the 12 months my endocrinologist will order more labs and a bone density scan and we shall see what he recommends next. I may go on another medication that will "lock in my gains".

I've been active all my life. I'm now 72-years-old and started lifting weights when I was in late 30's. I still lift weights, I walk, hike, x-country ski (when we have snow) and do yoga. My mother had osteoporosis and was very frail by my age with multiple compression fractures. I don't want to have that life so decided to follow my endocrinologist's recommendations.

I'm hoping you will be pleased with the time and attention you will receive at Mayo Clinic. The decision of what to do will be left up to you.

Minutes before I noticed this new discussion, I was saying to my husband what a hurdle it's been for me just understanding the role that each medical specialty plays in treating OP. Joining this support group helped me get over that hurdle. (Thanks everyone!) I'm very happy with the specialists I found, and the treatment I'm getting.
@stacibw I can empathize about how overwhelming it is. You really are fortunate to have that appointment scheduled with the Mayo. While you wait, if you can get a consultation with Dr. McCormick, that may be both reassuring, and good preparation for your appointment in July.
In the meantime, keep learning about OP, and advocating for yourself. You're on the right track!

After writing my previous comment, I saw one by @bluebonnet242. She's been trying to get an appointment with Dr. McCormick, and he's booked out until June. You can read her comment here: https://connect.mayoclinic.org/comment/1043669/
His opinion is highly sought after, so it may still be worth getting a consult even if it's after your appointment at the Mayo. He can't order tests, or prescribe meds. Instead, he can give you guidance, and if your doctor/s willing, he'll work with them to plan the best treatment for you.

This conversation has been very interesting to me. I would like to know if appointments with Mayo are in person or teleconferencing. I have been unsuccessful in finding any kind of expert in osteoporosis in CA. I would like to know whether those who have contacted Mayo and Dr. McCormick have done so in person or are able to do it via phone. I am going to try to relay off Prolia this month and my endocrinologist has very little experience in this procedure.