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Is Prolia a good option after Forteo?
kayaksandhiking posted:
I am 61 years old, female, was diagnosed with osteopenia at age 50, lumbar spine T score -0.9 and hip -1.2. I took alendronate/Fosamax for 9 years, plus calcium, VitD, and a multivitamin w/ minerals. No other health problems, very active. But over the 9 years I was taking daily biphosphonates, my T scores continued to drop, until I was -1.8 at the spine and -2.9 at the hip. So, 2 years ago I started daily Forteo injections, and now my T-scores are -1.0 spine and -2.9 hip. No side effects from Forteo.

So, good response with Forteo to the spine and at least no worse to the hip. I want to keep or improve my scores going forward. Since I did not have good results with biphosphonates in the past, I am considering other options to discuss with my MD. Does it seem reasonable to put Prolia at the head of the list?

All my lab work is good, by the way, with calcium and vit D levels in normal range. I continue to walk about 5 miles 4 times a week, do a lot of gardening, yoga 4 times a week, kayaking 2-3 times a week -- very active. Am a vegetarian, very little dairy.

Would appreciate advice, feedback. Thanks
bonebabe responded:
You're young for this. Has your doctor looked for a cause of your osteoporosis? Maybe it's secondary to something else. Forteo usually gives a better readout than this. However, T-scores don't indicate improvement and there are other factors to consider.

Family history of osteoporosis? Prednisone or antiseizure med use?

Lab tests are not good indicators of calcium for bone health. Your calcium would show in the normal range in your blood because the body takes from the bones to bring the blood calcium levels to what they should be.

You need 1200 mg of calcium each day. This should be taken at meal time, keeping in mind that the body will only be able to absorb 500-600 mg at a time - so spread it out.

I don't know if Prolia is a good choice for you or not. It's to be used only after all other meds have been tried. Talk to your doctor about it.

You were very young to have had such low numbers. I'm assuming you are not on hormone replacement. How old were you when you went through menopause?

It may very well be that you never really reached your full bone mass potential and when you started to lose bone, you lost rapidly because there wasn't a lot there.

I'd be real wary of the yoga and kayaking. Yoga is good for balance. Just be sure not to do any forward bending or side to side twisting of the spine. If I were you, I'd do something else besides kayaking. Just too risky and is not bone building either. The walking is good - no running. Gardening, just be careful, as with yoga, no forward bending or twisting of the spine.

Go on the NOF website for a lot more information. It's the gold standard of all things osteoporosis.
kayaksandhiking replied to bonebabe's response:
Thanks for the info. Yes, there is a hx of OP in my family. I personally have no other medical problems besides OP, was in perimenopause at age 49 when first diagnosed with osteopenia.I
consume fortified soymilk and OJ as my main dietary cources of calcium, plus taking citrical supplements and Vit D and I do get 1200 mg of calcium daily. I have never been on hormone replacement. I am considering Prolia as my best option only because I had no good results from Fosamax in the past.As a quality of life issue, I really want good strong bones because I love the activities that I do.

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