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When to start vs delay prescription meds for osteoporosis
I would like to hear comments especially from those who may have waited to start prescription meds and see if you're glad you waited. I know everyone's reasons and circumstances likely differ widely. I'm 70 years old. I've had bone density scans every 2 years for at least 5 years and all show numbers for osteopenia. My worst T-score is -2.3 in my left hip. Last scan was March 2025. But each scan shows some worsening in numbers. My PCP has always just sent a letter saying I'm at moderate risk for fractures and to take my calcium and Vitamin D. That's it. But I finally looked at all of the scans over the years again and realized that I need to get proactive.
Back in May, I tried to get an appointment to an endocrinologist, and restricted myself to a female doc that wasn't an hour's drive away, I could only get in to see someone Dec. 1, so I made the appointment. But then I found a PA in an orthopedic surgeon's office who was a certified bone densitometrist and I could get in in July, so I also booked an appointment with her and saw her mid-July. She asked if I'd ever had a fracture and I said I thought I'd broken a rib when I fell power walking about 4 years ago, but I never saw a doctor about it. She said that fracture would put me in the osteoporosis stage even though my numbers don't show it. She also said that resistance training and other exercises for bone strengthening only improve bone density about 2% and while she said it's good to do the exercises, she said that medication was what I needed. She gave me 3 possible meds to consider, Fosamax, Reclast or Tymlos. My issue is that I am a full time sole caregiver for my husband who has terminal cancer and needs help. I take him to numerous medical appointments at MD Anderson. I help him with bathing, meals, meds, dressing, etc. I'm afraid of the side effects of the meds, and even though I know not everyone gets them, I am concerned that if I was unlucky to get side effects, then I may not be able to help my husband sufficiently, especially if I were to suffer any prolonged time with painful side effects. I don't know if I want to take that chance and not be able to take care of him. He has declined enough that I really wonder if he'll have another year left. He's lost 50 pounds in the past year. He's dependent on a walker and the chemo has caused heart failure. So I'm leaning toward not doing any meds and asking the endocrinologist that I will see Dec. 1 to get me a PT order to do resistance training and weight lifting at least twice a week to make sure I'm using proper form and staying safe. I don't know how long Medicare would cover something like that, but it would be less expensive than going with a personal trainer and who may not be experienced working with people with osteoporosis. I'd recently had PT on me knee for a bone spur and after going twice/week for 4 weeks, my cost was only $29.29. In the meantime, I try to go to the gym twice/week and do the machines for resistance training and use the treadmill.
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@ipg , I have pie-in-the-sky dreams of getting back to normal BMD in the next year of Tymlos, then trying to do no follow up drugs if I can maintain BMD with just exercise and nutrition. Since I was able to increase BMD with exercise and nutrition before the drug (at a slower rate), I am hoping to do the same after. I want to convince my Dr to follow up with Dexas every 6 months. If BMD starts to slip, then I will reconsider.
If circumstances force me into a drug, I lean toward an Evenity type (bone builder and saver combo). I haven't fully researched my drug choices yet, I'll start in a few months.
My mom had a jaw like Swiss cheese after Fosamax, so I really want to stay away from it...
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2 Reactions@bellae2156 , For more protein, I switched the way I make coffee now. I use instant coffee in microwaved skim milk (calcium and about 12 grams protein). I add in 4 TBSP of collagen peptides. The peptides are not a complete protein, missing tryptophan, which is in the milk! That's another appx 18 g of protein. I also add cinnamon powder for it's anti-inflammatory properties.
I try any thing I can do to sneak in protein!
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1 Reaction@boneoptimist
Wonderful ideas and hopes. Good for you. So sorry about your mom. What was the result of her jaw? So scary
@ipg , Unfortunately she died soon after that was discovered. She didn't have the option for the bone builder drugs back then. My sisters and I have sworn off Fosamax because of her jaw experience!
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2 Reactions@ipg I don't know yet which Rx I may start with; I need to research them and then have questions ready for my Dec. 1 appointment with the new Endocrinologist; I want to see what she thinks.
@loriesco thanks for your response and how you did on Tymlos. I hope it works well for you. I haven't made time to research the drugs or much at all yet as I've been wrapped up with my husband's care. But I think I can start this week and catch some time to work on it all. You make some good points about the slow start and not to delay treatment.
I was hoping medicare would pay for weight training, unless you actually have an injury you'll have to pay out of pocket. I paid a pt who supposedly specializes in osteoporosis and she had me lifting heavy weights. I showed her my dexa before starting, however, she still had me lifting heavy with severe osteoporosis. I ended up with a stress fracture in my ankle. Please be cautious heavy lifting with osteoporosis. My doctor said I should never have been lifting that heavy. I ended up taking Tymlos with no side effects except a slightly elevated heart rate. Now I just lift light weights twice a week. Hopefully, after I grow lots of new bone I can add some weight. Best of luck.
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2 Reactions@boneoptimist
So sorry and very scary.. do you think she died from complications of that too?
@lbrown742
Apologize for redundancy. How long are you on Tymlos? Can’t always see prior threads. Why Tymlos not Forteo? And what will you do afterwards?
Thanks
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1 Reaction@boneoptimist May I ask about her jaw experience? That and the fact that I'm medicine avoidant scares me with regard to going on bone building meds.