What kind of plans are possible if you are looking ahead for many year

Posted by serious @serious, Jul 30, 2023

I am reading that Evenity is for one year; forteo/Tymlos for 2 years; Reclast for 3 years; bisphosphonates for 5 years; and Prolia for ten years of usage. I am also reading that Prolia requires a relay drug urgently if you stop taking it which may be one that you have already exhausted your life time quota. So, what are reasonable plans and sequencing if you are going to be on some sort of medication for a long period of time? For one thing, it seems like you cannot avoid Prolia as it is approved for the longest period of time of all of these.

Any thoughts?

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@judy58

Do any of you feel, that the right answer to make a decision as to how to treat osteoporosis is so convoluted,it makes your head spin? I just want to wrap my body in shrink wrap, and wait until more studies and research studies are conducted. I will continue to do research, and hopefully insurance companies and big pharma can begin to collaborate research on post menopausal women finally!

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It is very convoluted and punctuated by insurance and Medicare peculiarities. What a person on Medicare pays is influenced by whether the drug is a Part B or Part D drug. The difference can be thousands of dollars and not hundreds of dollars, bottom line, for the person.

I find a lot of the available information confusing to be polite about it. I remain completely confused if the restriction for being on a bisphosphonate is five years lifetime or five years but ok to resume if you are off this drug for a while. If it is “off for a while” what is awhile? I remain confused if Reclast is counted in this five years or not.

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@judy58

Do any of you feel, that the right answer to make a decision as to how to treat osteoporosis is so convoluted,it makes your head spin? I just want to wrap my body in shrink wrap, and wait until more studies and research studies are conducted. I will continue to do research, and hopefully insurance companies and big pharma can begin to collaborate research on post menopausal women finally!

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Might there be a medical revolution forming led by women?

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@teb

I can certainly understand your reluctance to go on hormones or to even consider recommending them since you have had breast cancer. There's still a lot we don't know definitively and the information out there is very confusing. What we do know is that the WHI was a flawed study and that the explanation of results was hyped and misrepresented. What was presented was the "relative risk" (I think it was somewhere around 25%) which made the risk seem quite high when in actuality, the "absolute risk" was determined to be an additional 8-9 people per 10,000, a very small increased risk. Now, any small increase in risk may be too much for some and I recognize and respect that. For those that need to arrest bone loss and are not happy with the other drug options, it's just one more thing to consider along with the risk/benefit ratio as each drug option would have.
Some other things to consider. Those on estrogen alone (only if you have no uterus) actually had a lower risk of breast cancer than those on estrogen and progesterone. There is some consideration that it may actually be the progesterone that increases risk. This needs further exploration.
The hormones used in the WHI study are different from what is generally prescribed today which are likely much safer. They used an oral estrogen, Premarin, created from pregnant mare urine. This formula contained several forms of estrogen, most of which would not be prescribed generally in menopause. Estradiol seems to be the safest in a transdermal patch at a low dose. This option bypasses the liver, unlike oral estrogen which must be processed through the liver.
The WHI study used a synthetic progestin which is now known to cause an increased risk. The safest progesterone available is micronized bioidentical progesterone.
When research studies are completed that suggest altering the course of previously held medical belief and practice, new protocols generally don't become common practice in the medical field for 15-17 years. We may be drastically behind the 8-ball here as many doctors still hold onto the decree of the WHI though there are some who are starting to shift their thinking and their recommendations.
Dr Avrum Bluming, an oncologist who has studied the research on HRT for decades has co-written a book called Estrogen Matters. He has many articles and interviews online that are very informative. Here is an interview that deals with the issue of HRT and breast cancer.
https://www.balance-menopause.com/menopause-library/explaining-what-the-evidence-shows-to-offer-choice-to-women-after-breast-cancer-with-avrum-bluming/
It's a complicated issue, no doubt. I just want to put it out there as an option to explore, research and consider depending upon one's personal situation and comfort level.

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can't edit the comment I made previously but wanted to add the actual percentages to further clarify the increased risk of breast cancer when on hormones.
From the New York Times ~ a woman’s risk of having breast cancer between the ages of 50 and 60 (the average age of the women in the WHI study) is around 2.3 percent. The Women's Health Initiative Study noted an increase in that risk of 26 percent and that's the number that was widely reported. That percentage is huge and scary. In actuality the 26% increase increased the risk from a 2.3 percent chance to a 2.94 percent chance, really a very very small increased risk. And again, this was on oral estrogen and synthetic progestin.

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@teb

can't edit the comment I made previously but wanted to add the actual percentages to further clarify the increased risk of breast cancer when on hormones.
From the New York Times ~ a woman’s risk of having breast cancer between the ages of 50 and 60 (the average age of the women in the WHI study) is around 2.3 percent. The Women's Health Initiative Study noted an increase in that risk of 26 percent and that's the number that was widely reported. That percentage is huge and scary. In actuality the 26% increase increased the risk from a 2.3 percent chance to a 2.94 percent chance, really a very very small increased risk. And again, this was on oral estrogen and synthetic progestin.

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I read in an article today that 13% of women get breast cancer. And 80% are hormone- driven.

But it is an interesting idea to look only at women ten years or so post menopause.

However it takes time for breast cancer to develop so maybe the study should have extended the time frame to 60-70. How long do the effects of HRT last?

I was 63 at diagnosis and did bioidentical HRT for a few months in my mid-50's. I have always wondered....

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@windyshores

I read in an article today that 13% of women get breast cancer. And 80% are hormone- driven.

But it is an interesting idea to look only at women ten years or so post menopause.

However it takes time for breast cancer to develop so maybe the study should have extended the time frame to 60-70. How long do the effects of HRT last?

I was 63 at diagnosis and did bioidentical HRT for a few months in my mid-50's. I have always wondered....

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it is unlikely that such short term use of HRT caused breast cancer. Agree completely that we need more studies on the long term use of HRT and use in older women. Such a complicated issue!

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