What medication should I takeForteo ,... - American Bone Hea...

American Bone Health: Osteoporosis

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What medication should I takeForteo , Prolia or Take my chances with nothing.

Charlottejoan profile image

My rheumatologist said I am going to have a hip or spine fracture and that will lead me to an earlier death, he said if I take the medication I will live longer. He wanted me to take FORTEO. he wouldn’t allow me to take Prolia. He said FORTEO build bone. Prolia doesn’t build bone. He said Prolia side effects with the jaw problem Necroses of the jaw. he never told me that I would lose bone if I stopped taking the prolia, I would’ve never taken it if I knew that it would damage my bone if I stopped taking it.Do you have any suggestions

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I am sorry to hear that you are not getting the help and correct info you need. After a insufficiency sacral fracture in July, I had a Dexa scan which revealed high risk osteoporosis. My endocrinologist immediately started me on Tymlos injections which I give myself everyday in my abdomen. I can only take it for 18-24 months, then I have to have a Prolia injection every 6 months for forever. Tymlos builds inner and outer bone. The Prolia can only be used to maintain the newly built bone. If you don’t use it after the Tymlos (or after Forteo in your case), you will lose all the new bone you built up. Have you had Dexa scan and lab work done by an endocrinologist? If not, you should probably do that.

Charlottejoan profile image
Charlottejoan in reply to Vaslim

Thank you so much

There are other options besides Prolia to take after Tymlos or Forteo. I'm not sure how they compare. I am currently on Tymlos, and have been told that I would take Reclast after that to maintain the bone that I will hopefully build with the Tymlos. Again, I haven't researched the difference, but I know there are other options besides Prolia depending on your health. Good luck to you. Sorry you are not getting the information you need. Take care.

Thank you

I was supposed to begin Fosamax for treatment. I have researched and listened to talks by experts in the field. I, also, began researching estrogen. I have decided that I am going to begin HRT again. The findings by the Women’s Health Initiative that said estrogen causes cancer and is bad for women have been revisited and revised. Study after study (I just read about 3 and can send you the links to that info) shows that estrogen benefits women and helps them to avoid the risk of disease as they age. I am reading a book that lays it all out.Estrogen is natural for a woman’s body. All of these drugs are not.

Here is an article I just read:

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Review

Estrogen therapy for osteoporosis in the modern era

V A Levin et al. Osteoporos Int. 2018 May.

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Abstract

Menopause predisposes women to osteoporosis due to declining estrogen levels. This results in a decrease in bone mineral density (BMD) and an increase in fractures. Osteoporotic fractures lead to substantial morbidity and mortality, and are considered one of the largest public health priorities by the World Health Organization (WHO). It is therefore essential for menopausal women to receive appropriate guidance for the prevention and management of osteoporosis. The Women's Health Initiative (WHI) randomized controlled trial first proved hormonal therapy (HT) reduces the incidence of all osteoporosis-related fractures in postmenopausal women. However, the study concluded that the adverse effects outweighed the potential benefits on bone, leading to a significant decrease in HT use for menopausal symptoms. Additionally, HT was not used as first-line therapy for osteoporosis and fractures. Subsequent studies have challenged these initial conclusions and have shown significant efficacy of HT in various doses, durations, regimens, and routes of administration. These studies support that HT improves BMD and reduces fracture risk in women with and without osteoporosis. Furthermore, the studies suggest that low-dose and transdermal HT are less likely associated with the adverse effects of breast cancer, endometrial hyperplasia, coronary artery disease (CAD), and venous thromboembolism (VTE) previously observed in standard-dose oral HT regimens. Given the need for estrogen in menopausal women and evidence supporting the cost effectiveness, safety, and efficacy of HT, we propose that HT should be considered for the primary prevention and treatment of osteoporosis in appropriate candidates. HT should be individualized and the once "lowest dose for shortest period of time" concept should no longer be used. This review will focus on the prior and current studies for various HT formulations used for the prevention and treatment of osteoporosis, exploring the safety profile of low-dose and transdermal HT that have been shown to be safer than oral standard-dose HT.

This is the book I am reading:

Good
Mark_ABH profile image
Mark_ABHPartner in reply to Katlute

Hi Katlute, the latest guidance (including the recommendations of the North American Menopause Society from a few weeks ago) does indeed support HRT for bone health for some women -- those within maybe 10 years after menopause. Note that this sentence from the abstract you provided uses the term "menopausal" rather than "postmenopausal."

Given the need for estrogen in menopausal women and evidence supporting the cost effectiveness, safety, and efficacy of HT, we propose that HT should be considered for the primary prevention and treatment of osteoporosis in appropriate candidates.

American Bone Health's medical board is still reviewing the NAMS findings, so I don't want to get out of my depth in discussing them, but you can find them easily via search.

My point is HRT seems to be a good option for women in the years immediately following menopause, not so much for women in their 70s, for instance.

Katlute profile image
Katlute in reply to Mark_ABH

What I have found in my reading does not agree with your comments. Consensus is changing on this matter.I have looked at 3 studies using estrogen for osteoporosis and each result was positive for using estrogen to treat osteoporosis in older women.

If a woman does not have coronary heart disease, estrogen is safe to use in the later years, long after menopause.

HRT IN OLDER WOMEN: IS IT EVER TOO LATE?

Issue: BCMJ, vol. 43 , No. 9 , November 2001 , Pages 517-521 Clinical Articles

By: Margo R. Fluker, MD, FRCSC

Short periods of hormone replacement therapy (HRT) are often used to treat vasomotor symptoms around the time of the menopause, but long-term adherence to therapy is low. However, there is accumulating evidence to support the initiation or re-initiation of HRT as a later intervention for a variety of progressive conditions associated with menopause and aging. If the risk-benefit ratio is in favor of HRT, various strategies can be used to improve acceptance and minimize side effects, with the goal of improving the quality, if not the quantity, of life.

As an alternative to long-term use of HRT as a preventive strategy, there is increasing support for periods of HRT use tailored to the woman’s current health concerns. This model focuses on treatment rather than prevention, and therefore has inherent limitations. However, it may be more appealing to those who dislike taking medications unless absolutely necessary, those who prefer to avoid medicalizing this stage of life, and those who fear that breast cancer risk increases with increasing duration of HRT.

In such a model, HRT might be used for 1 to 5 years in the perimenopausal interval to control vasomotor symptoms and irregular bleeding. A second discussion about the use of HRT (and other therapies), particularly for bone protection and relief of urogenital symptoms, may then be initiated in later life, depending on individual symptoms, health status, and risk factors.

Indications for late-onset HRT

Evidence is now accumulating to support the use of HRT as a later intervention for a variety of progressive conditions associated with menopause and aging.

Katlute profile image
Katlute in reply to Mark_ABH

Women need to know what all of their options are and, in order to do that, we need to know all the facts surrounding any health issue that concerns us.

The Medical Republic

1 SEPTEMBER 2017

How late is too late to start hormone therapy?

CLINICAL ENDOCRINOLOGY WOMEN

By

DR KAREN MAGRAITH

. Observational data suggest that transdermal oestrogen is associated with no increased risk of VTE (thrombosis).When discussing the possibility of beginning MHT in a woman older than 60, or later than 10 years after the menopause, the following approach is suggested:

• Take a detailed medical history with attention to cardiovascular risks, cancer, VTE and osteoporosis

• Explore the impact of her symptoms, and her reasons for seeking MHT at this time

• Discuss the option of trialling non-hormonal treatments for vasomotor symptoms (e.g. SSRI/SNRIs, gabapentin)

• Discuss the risks and benefits of MHT in an individualised fashion

• Consider transdermal oestrogen, and if a progestogen is needed, consider micronised progesterone or dydrogesterone as first options

• It is never too late to start topical oestrogen for genitourinary symptoms

Although most women seeking MHT are within the recommended time, starting in an older woman is not necessarily contraindicated.

With attention to cardiovascular health, and risks factors for breast cancer and VTE, along with selection of appropriate agents, this treatment is an option for some women.

Dr Karen Magraith is a GP in private practice in Hobart and a board member of the Australasian Menopause Society

In regard to the info in my earlier comment: the important fact is that the new research on estrogen reveals that there is no greater risk for cancer in women who take estrogen. That is what made me decide to stop. My mother had breast cancer at 70. But she, also smoked most of her adult life and was never screened. So, I was afraid. And it has affected my quality of life. Now, I have the beginning of osteoporosis, as well!

notanotter profile image
notanotter in reply to Katlute

No significantly greater risk for some types of cancer and for women in the youngest age range around menopause. That’s just the reslicing of the datasets from the WHI studies, these are not new clinical research studies.

Please consult with a cancer specialist if you have genetic risk factors. There are some forms of HRT that are less likely to be risky for people with the BRCA gene for instance.

I too wanted to avoid long term osteo drugs - as a younger diagnosed person - and I use HRT. But I and my friends who have been using the low dose patches and progesterone as suggested have still experienced multiple tumors and polyps. This is expensive and scary. I don’t think enough is known yet about the patches’ effects long term.

While so far all the tumors have been benign, it’s still a clear sign that HRT is not risk free. Many more cellular growths are happening than ever in my life. I’m meeting with my OBGYN next week to have another biopsy and will also either stop or slash the estradiol level. I’m clearly responding too strongly and not growing any bone either. If it were just me, fine but it’s also more than one other friend having the same experience.

Katlute profile image
Katlute in reply to notanotter

Thank you for your reply.

I am not talking about long term use. I am referring to use after many years of no HRT.

Also, in my research, I learned that the use of progesterone with estrogen can definitely cause problems.

Use of transdermal estrogen-only avoids those complications according to studies.

This is a personal, case by case decision that every woman has to make, based on her health issues.

I am 70, in great physical shape, not on any prescription drugs for anything, have never had cancer, never smoked, all my lab work and numbers are excellent. I have been fortunate, but have, also, worked hard to be healthy - starting in my late 40’s. So, my choice may be very different from the choice of a woman who has health/disease challenges.

I have met with my doctor and she is in agreement with my decision to try the transdermal patch for a month and go from there.

Katlute profile image
Katlute in reply to notanotter

The WHI studies/statistics have come under serious scrutiny for accuracy and has been shown not to be factual; also, their agenda may have been for other than the health and well being of women.

Katlute profile image
Katlute in reply to Katlute

I am so sorry for your health issues and pray that all will be resolved for you soon and that you and your doctor come up with a plan that is right for you!💗

Mark_ABH profile image
Mark_ABHPartner

Hi Charlottejoan, it's up to you, but users are encouraged to remain anonymous on this forum and not post pictures of themselves/use their real names etc.

Here is more information on FDA-approved treatments for osteoporosis: americanbonehealth.org/fda-...

Forteo is indicated for people with osteoporosis at high risk of fracture. It is supposed to build bone, not just prevent additional bone loss. You would need to take something else after a year or two, either Prolia or one of the bisphosphonates (one of the other users mentions Reclast, which is a once-a-year injection; other bisphosphonates are taken by mouth, sometimes daily).

One very important thing to remember about Prolia is not to miss an injection or stop taking it altogether unless you have a plan to start another medicine instead. You can have rapid bone loss and increased risk of fractures.

Good luck!

I started Forteo daily injections on Feb 2, 2021. Any side effects I had initially have gone away. The good part of taking Forteo is that it actually builds bone, something I really need to happen. After the two years, my doctor and I will have to decide on another treatment to keep the new bone. For years I tried to improve my bone health myself, but to no avail. My dexa scans just kept getting worse and worse. A friend of mine is a trustworthy pharmacist, and he said if a woman breaks a hip it many times is the beginning of the end for a quality life. I have grandchildren I enjoy and don't want that to happen to me. We have difficult decisions to make and have to weigh the pros and cons, but in my opinion doing nothing doesn't produce the needed benefits or results we need and want.

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