Value of Bisphosphonates if Not Losing Bone

[Lynnel17]

If my NTX score is good, shows I'm in the range for a premenopausal woman, will taking Fosomax help my BMD or risk of fracture?

My understanding is that some people's doctors measure their NTX pre-treatment, then redo the test later to see if the Fosmax has slowed bone loss. But what if bone loss didn't seem to be occurring before the drug?

I guess my NTX would suggest that my BMD is low because I'm not growing enough bone, but with a spine of -2.7, a hip of -2.4, and a FN of -2.0, it doesn't seem to me as if the situation would warrant bone building drugs either; at least, I'd be reluctant to take on those drugs with out seeing more need. Any information from your situation or readings you can offer to help me? Thank you.

[FearFracture]

A month ago I posted this on HealthUnlocked healthunlocked.com/american... trying to get help interpretting my bone turnover marker test results.

Today, I logged in and search for "bisphosphonates" hoping to find information on how exactly bisphosphonates work. I think you and I might be looking for the same information. Unfortunately, I didn't even know there were tests for bone turnover markers until after I'd followed my endocrinologist's advice to take bisphosphonates. I had my first bone turnover marker test done exactly 1 year after my 1st and only dose of zoledronic acid, which was in November 2021.

My endocrinologist ordered another zoledronic acid infusion for me for November 2022 but I decided not to have it because I had learned after the 1st infusion, through my own research, that my endocrinologist had not done any tests for secondary causes of osteoporosis and he has/hasn't done a few things that have lead me to not trust his opinions.

If you look at the link I provided above you will see that all of my bone turnover markers are within the normal range. My osteocalcin was 8.8 ng/mL and the reference range is 4.9 - 30.9 for premenopausal women and 9.4 - 47.4 for postmenopausal women. I am postmenopausal so technically I guess my osteocalcin is out of range but w/i range for all women.

The only comment my endocrinologist had about my bone turnover marker tests was that my osteocalcin is low but according to this pdf that I received when I signed up for a bone turnover marker webinar s3.amazonaws.com/Food4Healt... bisphosphonates are expected to lower osteocalcin. The pdf also states that some other conditions, such as hypothyroidism, can lower osteocalcin. I have hypothyroidism and my endocrinologist knows that I have it because he was treating my hypothyroidism prior to my being diagnosed with osteoporosis. What I can't understand is why if my osteocalcin is already near the bottom of the range, and my endocrinologist seems to think this is a bad thing, would he want me to have another dose of zoledronic acid which should cause my osteocalcin to drop even lower.

I've been hunting for info on how to increase osteocalcin and where it should actually be. During my searches I came across a few pieces of info that make me doubt the validity of my osteocalcin test results. The first thing I found seemed to say that after the blood is collected for this test that it needs to be kept at extremely cold temps and the test needs to preformed soon after collection. The second thing I found said that postmenopausal women are able to increase osteocalcin via exercise. I joined a gym last year and go 3 times a week. Additionally, I walk most days. If exercise increases osteocalcin and my levels are near the low end and the test was done accurately, then my endocrinologist should be concerned that something else is way off.

I think that you and I are thinking the same thing, if our bone turnover markers are in the normal range, how are bisphosphonates going to help?

Mark_ABH will you please comment on Lynnel17's post and mine. It would be greatly appreciated.

[Aerobics-Instructor in reply to FearFracture]

thank you for this very helpful pdf! My turnover markers were also low, despite a T score of -3.4, and are now even lower after being on Fosamax. So I'm also wondering if I should be on a bone-building drug instead, since I don't seem to be breaking down bone too fast? I'll investigate that further. I also have high urinary calcium (not due to kidney disease or thryoid or parathyroid issues, or anything else) which has now been controlled by keeping to a very low calcium diet (yikes!! So HOW are my bones supposed to be getting enough calcium?) Finally, my vitamin D is 35 ng/mol, so I've upped my supplements to 3,000 IU's a day to help with calcium absorption (instead of excretion). I've never had a fracture so my doc isn't really too interested.

[FearFracture in reply to Aerobics-Instructor]

In the fall of 2021, I had a routine colonoscopy, which meant limiting my diet for a few days before and no food 24 hours before thus depriving my body of needed vitamins and minerals. This may be perfectly fine for a healthy 25 y.o. but all I could think about was that I was losing bone.

Afterwards, I searched for vitamins/minerals in a patch form to see if they are available and found that they do exist. Since you can’t take calcium supplements orally, you could ask your doctor about getting calcium via a patch. I have no idea if getting calcium through a patch would work for you, meaning if it would help you get calcium and not lose it through urination but it might be worth asking about.

I’ve never tried these but here’s a link to one that I found freshlynutrifood.com/produc...

The next time I have a colonoscopy or any other procedure that requires fasting for more than 12 hours, I intend to use some form of vitamin/mineral patch.

[dcdream in reply to FearFracture]

Reading all these comments and how women are researching for answers and that doctors don't seem to do all the proper testing before prescribing meds, makes me question the entire system doctors use to pass out these drugs. It appears some doctors can't answer the questions, don't have all the research or time to understand this medical problem sufficiently. I also know from talking to women who take the meds and then go off them to take said holidays, over time, they seem to continue to lose density once off requiring a new drug that often requires lifetime use and they often fracture. I've seen this with my mom and her generation, the first to be put on these meds for two decades. This reminds me of how statins were developed, pushed and used decades ago. When you read the development of osteoporosis meds, they followed a similar path with pharmaceutical companies developing drugs, developing the machines to test and then determining the scores that require meds. Same with blood pressure meds, which now after decades of pushing meds, they revised the actual scores for when to begin drugs. As with statins, blood pressure meds, etc. decades later they know more about the consequences, side effects and when to use these meds more effectively. Two decades later, women are still waiting for research to show us how these drugs work over time and how successful they are over decades of use compared to those who don't take the meds. When one inquires into why said drug manufacturers don't provide said research, we too often are told, proper testing takes time and money, both of which they don't have time or interest in doing. We are the guinea pigs on this for future generations.