What is next if Forteo does not work?

I took Forteo for two years it worked ! Keep
Going !

I would stick with the Forteo. Clearly research is not completely understood in the area of Osteoporosis and prior bone meds do impact on how each subsequent medication works. That's why sequencing is so important, and they are just figuring that out now. Forteo is one of the best bone builders in my humble opinion. I took it in 2016 for the full 24 months and have not fractured since (I had 13 compression fractures and two arm fractures before Forteo). I am now on my second course of Forteo (Teriparatide) and grateful to have this medication. Luckily for me, my body had severe reaction to Bisophomates , so by not taking those, I think the Forteo was more effective.

But what do we take after the anabolic if we can’t do biophospanates?

Hi redlo,
I have a couple of questions if you don't mind. Was the DXA you're using as baseline done before or after Fosamax? Also, when was the CTX of 750 measured? From what you wrote earlier, I wasn't completely sure of the timing.

It's quite possible that prior Fosamax use is contributing to the lack of measurable BMD change so far, even your bone markers showing good anabolic activity with Forteo. If you happen to get a newer P1NP at some point, would you mind keeping us updated?

Just to share my own experience: my response to Forteo was on the slower side too. After 13.5mo, my lumbar spine BMD was up about 4.9%, but there was essentially no change in BMD at the hips or femur necks. My P!NP at 13.5mo was very high (400+) showing great anabolic response btw. It wasn't until the second year and well into the antiresorptive phase when I saw much more noticeable BMD improvements across all sites. And that was without any prior treatment before starting Forteo.

From what I've read, newly formed bone matrix (osteoid) could take time to fully mineralize, so DXA changes could lag behind the responses we see in bone markers. In that sense, a flat scan results at this stage doesn't rule out meaningful improvement underneath.

@broken13 You took Forteo for two years and then stopped without another drug and held onto your gains for 5 years? Is that correct?

@lightlifts If you can't tolerate the biophosphates you can take Prolia.

@soggybones No. After the Forteo, I had one shot of Prolia, then 5 years of Evista/Rolaxafine.
I had a dental reaction to Prolia, so took the Evista. It held gains with "no significant change" noted on my yearly bone density. However, the insignificant change over 5 years added to a drop, so I am on another course of Forteo, but the bioidentical brand Teriparatide. I have 4 months left on the 18 month course. I will have bone density in January to see how I have done. Feeling hopeful!

Interesting treatment plan....I have a lot of dental restorations so I'm scared to take bisphosphonates. You didn't develop ONJ after one round of Prolia did you? I certainly hope not! I would like to start on Forteo and then transition to HRT, but I have a high risk of breast cancer so I was thinking of Evista, but I heard it isn't as strong. Anyway, I hope the Teriparatide works well for you!

@soggybones you can only be on that 10 years. Im 69.

Maybe by then they'll be something after Prolia!