Update after seeing Stanford Bone Clinic endocrinologist

Posted by oopsiedaisy @oopsiedaisy, May 21 1:07pm

Someone asked me for an update after I had seen an endocrinologist affiliated with the Stanford Bone Clinic.

I had my appointment in late April and it was quite interesting. The doctor told me that she suspected the Fosamax had stopped working for me and that was why my bone density decreased and I fractured. That wasn't something I'd considered at all. I was on Fosamax for over five years.

She ordered a bunch of tests (many are mentioned in the Great Bones book by Dr. McCormack) including CTX, cortisol, and 24 hour urine.

Turns out my cortisol level is low (big shock as I thought it would be high). I am getting retested on Friday.

CTX was in the mid-300s.

I also have hypercalciuria. I have really upped my protein intake since my fracture and have to wonder if this may be a factor.

She quickly got approval for me to start Evenity and I have my first shots on Friday.

I was very pleasantly surprised about how thorough and knowledgeable this doctor is when compared to the rheumatologist I saw last year and am very glad I pushed for a referral. I feel like I am now getting better care.

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

oopsiedaisy | @oopsiedaisy | Jun 2 10:09am

In reply to @mayblin "Thanks for sharing @oopsiedaisy. Are you taking HRT currently? Wish you a great success with Evenity!" + (show)

Yes, I started HRT at age 51 and have been on it now for 13 years.

mayblin | @mayblin | Jun 2 11:21pm

In reply to @oopsiedaisy "Yes, I started HRT at age 51 and have been on it now for 13 years." + (show)

Thank you @oopsiedaisy for this info. May I ask what dose and route of estradiol you are using?

I saw that your CTX readings at mid 300s on HRT (your recent baseline). By comparison, my CTX is getting down to low 100s on 0.025mg/day transdermal estradiol which makes me to wonder if this is over-suppression of bone turnover in a long run.

oopsiedaisy | @oopsiedaisy | Jun 3 9:19am

In reply to @mayblin "Thank you @oopsiedaisy for this info. May I ask what dose and route of estradiol you..." + (show)

I am Estrogel transdermal 0.06 mg/day plus progesterone 100 mg/day oral.

Are you on any other medication that might be suppressing your CTX? Has your P1NP been tested to see if you are building bone?

She did not test my P1NP which would have been interesting. I guess she's going off whether my BMD increases on the Evenity.

mayblin | @mayblin | Jun 3 10:20am

In reply to @oopsiedaisy "I am Estrogel transdermal 0.06 mg/day plus progesterone 100 mg/day oral. Are you on any other..." + (show)

I appreciate your reply! This makes me wonder whether I’m very sensitive to estradiol, or, gel form vs patches (which I’m using) makes a difference.

I’ve been on HRT for almost a year now since the completion of Forteo. The intention was to use it as maintenance as I’m now in osteopenia range. But CTX kept trending lower and lower; P1NP too (in 20s). This sounds good for now to minimize remodeling but does raise the question of optimal outcome in the long run.