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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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I would suggest trying to get Evenity
It is an anabolic med, injection once monthly at clinic for 12 months. It seems the most effective to build bone and few people have side effects. Don’t take an antireabsorptive drug first or it will blunt effects of anabolic drug
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1 ReactionA few things I’d consider:
1. Is there a way to confirm you had a previous fracture from your fall with an X-Ray?
2. Consider your current health. Are you active and fit with core body strength? Are you a fall risk at age 70. Or did you fall and not break anything suggesting your bones are not that fragile?
3. Taking an oral pill like Fosomax or Boniva may have fewer side effects than an Anabolic, and you’d slow your bone loss.
4. Also your endocrinologist can test your bone turnover markers which would give you a better idea of your current bone building vs bone decreasing ratio. (That’s not the medical term just a description.)
Looking at those considerations would help you determine how aggressively you should treat your disease.
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4 ReactionsI am 71 and have had a diagnosis of -2.7 in my hip signaling osteoporosis but I have done a ton of research and talked to my doctors and rheumatologist and all have agreed to let me take algiecal plus and to lift weights and take vit D, collegian and now going to add creatine for my bones. I am taking and AI med because I had breast cancer in 2/25. That also depletes bone. But the treatments of Prolia and recast don’t build bone and require lifetime treatment. I do not want to start other drugs so I continue to lift weights and attack the problem with food and vitamins etc. I advise you to google a report released by NPR about the creation and history of Fosamax and do your research. It sounds to me like you are making the right decision now. You are healthy and strong and working to keep it that way.
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3 Reactions@boneoptimist I meant to have asked you how much weight you are now lifting and did you initially have supervision, or still do? I'm really hoping I can get preauthorization from Medicare for physical therapy to start me on lifting weights so I can learn proper form, and what to avoid, etc.
@nott56 Thanks for your response. Yes, I'm going to ask the endo about an xray to confirm that I had a rib fracture 4 years ago. And I plan to ask about getting the blood tests you referenced. I think they are a serum CTx and serum P1NP. I am active, but not as much as I need to be. I walk my dog 2 miles/day and try to keep up a brisk pace once she's "done her business", so I keep her stopping and sniffing to a minimum, sometimes walking in the street to maintain that. Sometimes jog short distances during walking my dog. I go to the gym and do the treadmill for 30 minutes, alternating with jogging and walking and then do some machines. My core strength can be improved so I'm always trying to work on that.
@wews Thank you for your response. I have just googled and found the NPR report on Fosamax you mentioned. I had no idea this was out there and plan to listen to this today. I've heard of algaecal, collagen and creatine and need to check those out. Currently, I only take Vit D3 2000 IU/day and a calcium supplement, plus try to eat 5 prunes/day. The prunes support bone building and help to supress bone loss. I also am trying to track my protein and calcium intake through nutrition. I would prefer not to take prescription meds, but the PA I saw says I need to, so I'm going to see what the endocrinologist I see in December will say. I've read that the drugs are all a lifetime treatment, moving from one to another after a period of time. So I do need to ask the doctor and research that as well. Best of luck you you! I would be very interested in knowing you continue to do with the regimen you currently are taking.
@bellae2156 , My daughter's nickname is Bella! It's a good idea to start with PT to get good form! There are therapists who specialize in OP, so see if you can find one.
I have been lifting weight (dumbbells and machines) on and off since I was like 12 (for sports) so I am very comfortable doing it on my own. My last stint of daily lifting (5 days/wk) was 2014-2024, until I retired in 2024, and started at a new gym, where I continued. Unfortunately, all the ten years I was eating too little protein (only 30-40 grams a day), so I didn't get the full effect of the exercise. I also didn't separate my calcium and magnesium, so not good absorption there! And my estrogen was very low, and so here I am.
I do legs on TU TH, and arms on Wed, and abs/core, balance, and leg slams on all three days. Each session starts with 45 mins on treadmill, about 40-50 mins of weights, and 20-30 mins of stretching after. On M, F and Sunday are appx 20 mins treadmill and then pickleball with shorter stretching before and after. I do a weight as heavy as I can handle to finish 2 sets of 8 reps to start. By the second set , 7th and 8th rep feels almost like I won't be able to finish. I record that weight and reps, and next time I do that muscle group, I will try for 2 sets of 9 reps, going up 1 rep each time. When I hit 2 sets of 14 reps, I will up the weight (5lb for arms and 10 for legs) and do 2 sets of 8 again.
I had PT for hip bursitis a couple years ago, and I noticed that one side of my body was stronger than the other (you have a dominant side of your body) so then I switched to doing a lot of the exercises on the machines with single arm or leg if possible. So leg presses I do one leg at a time on the machine. Each leg is like 60 lbs now, calf raises I do 95 lbs, single arm biceps are 40 lbs. I also do wrist curls and reverse wrist curls, twisting wrist,etc, all about 12-15 lbs. Pecs and fly I think is 60, inner/outer thigh is 50, etc.
I started out at low weights originally, and worked my way up. Treadmill, I could only do like 10 minutes at first. I get SOOOOO bored on treadmill, so I either read a book, or play games.
Consistency matters more than perfection or heavy weights. Once it becomes a habit, you are all set. If I don't have time for a full workout, I will still go to the gym and just do the weights portion. If I'm mildly sick, I might still go and just do stretching on the mats. That keeps up the routine.
To other lifters out there, a question: When you have to miss 2 or 3 weeks at the gym (due to sickness or a long vacay), where do you restart at when you come back? I sometimes go back in at 80% of where I was, but am I just being lazy? What do you do? (Pleasepleaseplease don't say you lift on vacay-I refuse to!)
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1 Reaction@donnabutcher Thanks for your response. I will research Evenity before my appointment Dec. 1.
@boneoptimist Wow, I'm impressed by your regimen! Thank you for being specific. I hope to work my way to that. I've been doing 50# on the leg press, but with both legs at once. I've also been doing 40# on the leg abduction/adduction machines, 40# on the lateral pull down machine, 55# on the triceps machine, but all with both arms/legs. I do feel my right leg is stronger than the left, same with my arms. I hadn't even thought about doing it with one arm/leg at a time. I assume when you went to one leg, you reduced the weight before you got to where you are now? When you are lifting weights, are you using a barbell with weights on it or something else? Or hand weights? Stretching is something I need to incorporate more consistently. Lots to work on! My grandkids love pickleball but I've never done it; it sounds like it would be fun. My gym put up a notice that they are permanently closing the end of October so I'll be transitioning to another location, a little over twice as far away. Ugh, but I need to do it. Thanks again. You inspire me!
@bellae2156 Wow! The weights you use are a great start! Woot, woot!
My gym has the dumbbells with the set weights on them, from 5 lb to I think 50lb? The machines go higher, of course.
Yes, I went to just under half of the weight when I switched to one leg/arm. Since I'd never done it before, I wanted to make sure my form felt right and stable before I raised the weight.
How long have you been lifting, and many Dexas have you had? I can't remember what drug you are on? I'm sure you will see progress on your next one!!
Proud of you! Keep it up Bone Warrior!
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