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American Bone Health: Osteoporosis

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which is the better treatment for osteoporosis for post menopausal woman of 78 years?

smtamt profile image

My mother Sobha Ghoshal (now 78 years in 2019) has taken Bonmax Pth (teriparatide) injection for 2 years (spanning from October 2015 to September 2017) for Osteoporosis.. But after completion of 2 yrs, the T- score did not did not improve from the first BMD Test in the femur neck left and right. The BMD test comparison chart is given below for your kind perusal and consideration. Both the tests were done from Qudra, Kolkata- 7000019.

BMD TEST done on 19.09.2015

RegionT-Score

Femur Neck Left (hips)-2.2

Femur Neck Right (hips)-2.1

AP Spine L1-L4 is 1.007 g/cm2 (spine)-2.2

BMD Test Done on 18.09.2017

RegionT-Score

Femur Neck Left-2.2

Femur Left Right-1.8

AP Spine L1-L4 is 0.920 g/cm2-1.4

From the chart you can see that though, there is drastic improvement of BMD in AP spine from -2.2 to -1.4 but in the Femur Neck Left (hips) there is no improvement. Teriparatide subcutaneous injection failed to increase the bone density in the hips and so the risk of hip fracture is still there after completion of 2 years course. It works magically to increase bone density in AP spine but not the hips. It does not add/increase any bone density in the femur neck left and right. So I want to know what is the best cure to add some bone density in the hips so that it does not easily break after fall. Which is the best treatment for post menopausal woman of 78 years : a) Prolia (denosumab injection) or b) Aclasta (zolendronic acid) ?

smtkrgsl (son)

19 Replies
HeronNS profile image
HeronNSAmbassador

None of the t-scores you list are in the osteoporosis range, which is said to begin at 2.5. However, as she has been on a bone med there is a possiblilty of rebound bone thinning unless something else is given. I believe, if she can tolerate it, one of the bisphosphonates is probably the simplest, and I think for however long they think the after effects of teraparatide are significant. May be a year.

However, was your mother ever assessed for secondary causes of osteoporosis to discover why her bones have not responded to the medication?

As you doubtless know, nutrition, including a few supplements like Vitamin K2 (not K1) and Vitamin D, and appropriate exercise are necessary for good bone health.

I'm in a hurry right now but will add more later.

HeronNS profile image
HeronNSAmbassador in reply to HeronNS

Here are a couple of links. Hopefully there will be something useful in them:

americanbonehealth.org/bone...

healthunlocked.com/pmrgcauk...

smtkrgsl profile image
smtkrgsl in reply to HeronNS

Can you make a diet chart for my mother? What other supplements she should take in order to increase bone density and bone quality? What health drinks she should take everyday? Please help with your valuable suggestions.

HeronNS profile image
HeronNSAmbassador in reply to smtkrgsl

I am sorry, I cannot go into any details like that as I am only a patient like your mother (although no meds in my case) and most of the information I have gleaned is in the link I sent of my own experience. There are a couple of useful websites. Ignore what they want to sell you:

betterbones.com/

saveourbones.com/

They have good ideas and suggestions for safe exercises.

As Heron says, those scores are only in the osteopaenia range and are extremely good for someone your mother's age! Has she had a fragility fracture? If so, she would still be classed as having osteoporosis. If not, there's no good reason for her to be taking meds.

HeronNS profile image
HeronNSAmbassador

Oh you asked about a couple of specific medications. Please avoid Prolia. If you do a search of the HealthUnlocked site for Prolia (aka denosumab) you'll find many stories about how Prolia has ruined people's lives.

I wouldn't touch any of the horrid bone meds that are available and prescribed! Please research these...don't let your Mom take any of them! They should all be taken off the market....

lawdog profile image
lawdog in reply to sweetsusie

Sweetsusie, with your knowledge of which meds you are REALLY against big time, could you share their names with with me? I am starting now to check out any ones that may be suggested by my MD next April/May when my Reclast ends it's 1 year effectiveness. I researched about every type of med several years ago when the MD was encouraging me to use the Forteo, but I would need to pull out my file to remember which ones and then see if there any updates on them. I respect your opinion a great deal.

sweetsusie profile image
sweetsusie in reply to lawdog

Well...thank you lawdog, but I'm no expert...I took Fosamax for a couple of days and ended up not being about to swallow. Then my doctor suggested Reclast, but when I researched it, I was to scared to take it due to the side effects mentioned. On this site, Prolia is the WORST from everything I've read here and researched on my own. I think they're all about the same, in that, they are not good for anyone to be taking them!

lawdog profile image
lawdog in reply to sweetsusie

Thank you for answering. Appreciate you doing that. I'm doing well so far on the Reclast infusion last May.....it is also used for cancer patients on chemotherapy because it counteracts excess calcium in their blood. When I had my infusion I was the only one receiving it for osteoporosis. Were at least 20 receiving it for the calcium issue. I have no knowledge about Fosamax. I'll check that out. Sometimes I think when I read about all the things which CAN happen, I need to remind myself to also read how often does that reaction happen. Well we really are all unique beings with unique bodies. The Prolia is working well with my sisters. They have not had a fracture, so Forteo was not recommended to them What are you doing for yourself? Know no meds are involve.

sweetsusie profile image
sweetsusie in reply to lawdog

I am 71 years old and my doctor allows me to take HRT (hormone replacement therapy). The estrogen/progesterone combo (and estrogen alone) will rebuild your bones. That's all I'm doing..but you will find loads of good advice from all the people on this site! They are wonderful and very knowledgeable!

smtamt profile image
smtamt in reply to sweetsusie

I have been told that Prolia (denosumab) is less effective for reducing hip fractures and increases infection risks. Can Prolia increase bone density in the hips (i.e. Femur neck left and femur neck right) and reduce the risk of hip fracture after a fall or should my mother go for Reclast / Aclasta (zolendronic acid) to reduce the risk of hip fractures? All the medicines (prolia/teriparatide/ Aclasta) works works magically to increase bone density in AP spine but not the hips. Can Biphosphonates like Reclast or Aclasta be taken for more than 3 years? Can my mother stop Prolia after taking it for 5 years or will it again enhance breaking of bones in hips and spine? Is estrogen therapy god for 78 years old post menopausal woman?

Bet117 profile image
Bet117 in reply to sweetsusie

Thank you! I took ReClast for 5 years; no outward side effects and was told the meds have worn off. My endo tried to sell me on Romosozumab, without looking at my family and present history of diagnosed Membraneous Nephropathy an autoimmune kidney disease in 2017, during which I was his patient. His services have been terminated. My nephrologist recommended Prolia or Boniva for kidney patients and I am seeing the

second opinion this week that he recommended. Thank you for the feedback as I am not comfortable taking meds with all of these side effects.

Any thoughts or support?

Thanks!

Bet

Hello. Hello, and welcome. But perhaps share a little less personal info like your Mom's namd and showing medical exams on this venue. For your protection, and privacy. Once something is printed on this venue, it is out there in world and no way to stop it. Please considering checking the box that says for this community only after you write a post. That helps some with the privacy.

So your Mom is not a great deal older than me and she appears she had "Forteo" like me for about two years. She really needed to be on a maintanence med immediately after the last of the Forteo to prevent the loss of the bone density and improvement that she did receive.

Osteoporosis and meds for it are very controversial, and each one has pros and cons, so women have difficulty in deciding what to do about it.......SO this is just my experience and my opinion, nothing more. I have written a rather long POST early in this year (2019) about Forteo (Forsteo) which is the brand names for the medication with the daily injections I and looks like your Mom, had for approximately 2 years.

My doctor is Board Certified Rheumatologist, the type of speciality MD who is considered in the US to be the "to go MD" regarding osteoporosis. Before my two years was up on Forteo, we decided together, what maintenance medication I would take. It was an infusion of Reclast which will last a year. Then next year the MD and I will decide again what would be a good maintenace med.

Osteoporosis is a condition often requiring medical maintenance care. Healthy eating and weight bearing exercise help. But when I fell and had my first fracture ever in my life, I agreed with my MD it was time to get aggressive and add Forteo. I am very happy your Mom had it available for her. Appears more difficult to have it RX in Great Britian.

Many women I have read on this venue are horrified by Prolia, but to save my soul, my sister takes it twice a year and is doing great. Another sister is considering it. And they have done all the reading and advice of the pros and cons of Prolia.

So If your Mom isn't being treated by a Rheumatologist, in MY OPINION, she should consider seeing one. I had a 12% increase in bone density with Forteo WHERE I needed it...and the spine improved more than the hip, but not by much.

As far as I know, Forteo is the only med that creates bone matter and sends it where it is needed most. How Forteo works is a different approach than anything else available. But there is really no reason to bore you on that here. All of us are a different package and may respond differently to any of the meds.

So keep us posted, but I do believe the next step for your Mom is to consult with a Rheumatologist about what medications are available and which one he would recommend for his Mother , sister or wife. My MD had three out on the exam table, but by asking him that question, he immediately chose Reclast infusion for me. Maybe your Mom could ask the same question. :)

I entered a long reply above, but looked at your Mom's exams you posted. Like me there was not much increase in bone density in my hip..........but there was no loss of any significance either. My MD explained Forteo DID help by stopping progression of bone loss there, so that was a success. My spine had 12% increase in bone density because I needed much more there.....That was a huge success for me and my MD.

smtkrgsl profile image
smtkrgsl in reply to lawdog

For how many years Forteo can be taken? Can my mother (81 years old) take this injection forever till her death like Prolia? In India similar injection in the name of "Bonmax Pth" had been taken for my mother for 2 years (maximum one can take) from the year 2016 to 2018.

Mark_ABH profile image
Mark_ABHPartner in reply to smtkrgsl

1 or 2 years.

I have been told that Prolia (denosumab) is less effective for reducing hip fractures and increases infection risks. Can Prolia increase bone density in the hips (i.e. Femur neck left and femur neck right) and reduce the risk of hip fracture after a fall or should my mother go for Reclast / Aclasta (zolendronic acid) to reduce the risk of hip fractures? All the medicines (prolia/teriparatide/ Aclasta) works works magically to increase bone density in AP spine but not the hips. Can Biphosphonates like Reclast or Aclasta be taken for more than 3 years? Can my mother stop Prolia after taking it for 5 years or will it again enhance breaking of bones in hips and spine?

lawdog profile image
lawdog in reply to smtamt

Hi! Sorry, but all those medical question that should be answered by your mom's rheumatologist, I don't know if any of the meds you mentioned actually build bone density in certain body areas or not or if they act more as an agent to prevent further loss of bone density, If you don't mind me asking, are you your primary caregiver of your mom and your age. Was wondering if you are also dealing with osteoporosis. Believe still, that perhaps you and your mom need an appointment with the Rheumatologist who specialises in osteoporosis care and is caring for your mom. I am only one person beig treated for it, and my knowledge is limited to that.

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