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    Forteo - Spine & Hip Density
    megmo84 posted:
    Hello All,

    After one year on Forteo, I am excited to report that my spinal BMD has increased from a T-Score of -3.6 to -3.1 (Z-score -2.5 to -2.0). However, my hip density has declined slightly from T -1.2 to -1.3 (Z-score -0.4 to -0.5). I've read this is a typical phenomenon of Forteo. Would someone explain the mechanisms behind this discrepancy between spine and hip improvements? I appreciate your insights.
    bonebabe responded:
    You have to look at the BMD and calculate the actual change in bone density and then see if it's greater than the lowest significant change before saying you've had an increase or decrease. That determination is not made by T-score. Our lowest significant change in our osteporosis center is .029 for the spine and .028 for the hip - or roughly 3%. Anything less than that (and probably a T-score of -1.2 to -1.3 is) is considered a non-change or stable.

    To answer your question of why the spine and hip can show change that is not consistent is because bone in different parts of the body change at different rates. The hip bone is cortical - a thicker bone and the spine is trabecular, a thinner or honeycomb bone.

    Also if you're past menopause, ignore the Z-scores. They don't apply to you.

    This is very exciting news about your improvement. Just wait till next year :)
    megmo84 replied to bonebabe's response:
    Hi bonebabe - Thank you for your feedback. I am 26 years old so Z-scores are relevant. Given the difference in cortical and trabecular bone, should I expect/hope for an improvement in my hip density in the months to come?
    bonebabe replied to megmo84's response:
    26 years old and on Forteo?? What's going on to cause your bone density to be so low? What tests has your doctor done to find out? Your situation is very unusual because you're premenopausal and possibly have not reached your peak bone mass.

    How old were you when you had your first DXA and why did you have one? I'm simply floored.

    Now that I see the connection between this post and the one about colas, my perspective has changed. I'd quit the colas altogether. Those scores are too low and you're already on Forteo to jeopardize any improvement even with something as innocuous as a soda.

    Your hip may or may not improve in a year. Bone grows and loses at different rates. I'd think it would, but then I'm suspecting the osteoporosis as secondary to another condition that could compromise any gain. If you're not walking at least a half hour every day, start doing that.

    By any chance are you pregnant or breastfeeding?
    phototaker replied to bonebabe's response:
    Have you had an eating disorder or used prednisone for asthma? Did you have cortisone shots or have IBD? All these can contribute to bone loss.
    megmo84 replied to bonebabe's response:
    My osteoporosis stems from an eating disorder I developed at age 12. I was diagnosed with osteoporosis at 16 and took a variety of bisphosphonates for the next several years. At 23, I began my first two-year stint on Forteo. (I was too naive to pay attention to the DXA results at that point.) After that was discontinued, my bone density decreased. (I should mention that my tests were performed on different machines each time.) I began my second round of Forteo in November 2009.

    While I am happy to report that I am now in recovery, my weight remains low and I do not have regular periods. Estrogen defieciency -- an obvious contributor to bone loss. That said, I strive to practice bone-healthy habits: frequent weigh-bearing exercise, a calcium-rich diet, stress management, etc. and am conciously working on weight gain.

    Thanks again for the community input.
    phototaker replied to megmo84's response:
    Glad to hear you're on the road to recovery, and doing so much better. Having an eating disorder is so tough to overcome. I commend you on your efforts! Good luck!
    vlbWorrell replied to bonebabe's response:
    Hello bonebabe

    I am new to chatting and hope I am reaching you inthe proper way.....if not please advise and my appologies to megmo84.

    You sound like you could help me with the issues I am facing. Please refer to "Feeling old and uniportant." Your imput would be most welcome.

    In addition to that post I am including this additional info.

    The ortho Dr I saw that said I did not need a new hip called yesterday and said that he had spent some more time reviewing my films and realized that I do indeed need a new hip, ASAP.

    He said he was sorry and because I was getting around so well he initially did not see how bad my hip is.

    We are in a medium sizes medical community. He said he would not recommend me having a revision here. He recommended that I have it done in a university setting.

    I am totally floored and do not know what that means or what my next step should be
    bjhodg56 replied to megmo84's response:
    "first two-year stint on Forteo"...I hope you dont mean you are now starting your third year of are only supposed to take it for a total of 2 yrs...
    megmo84 replied to bjhodg56's response:
    Yes, this is my third year of forteo. I understand the uncertainty of Forteo's safety beyond two years. However, my doctors felt the benefits of the drug outweighed the potential risks hinted by existing evidence.
    bonebabe replied to vlbWorrell's response:
    I read your previous post and it looks like you've gotten some good feedback from the wonderful people on this board.

    Isn't it fortunate that you are able to have a new hip and probably eliminate some of your pain? That is good news while I understand the thought of yet another surgery is a pain.

    I'm sure your doctor will recommend some physical therapy after the surgery. Ask too about some body mechanics and Activities of Daily Living instruction when doing the PT.

    You might also want to research the Reclast - the annual IV osteo drug. It's paid out of your health insurance, not drug insurance and is especially effective for the hips.

    Are you near any university hospitals? If so, ask your doctor for a referral to a doctor on staff there to discuss your options.

    You can also order the NOF booklet "Boning Up on Osteoporosis." It addresses all aspects of osteoporosis, including the emotional.

    Don't let this setback limit your growth as a functioning creative person. You are not your hip. There are solutions for you. I'd also suggest some kind of group involvement. Ask at the university hospital or look online for osteoporosis or arthritis support groups. We have both here at the hospital where I work and they're great. I think actually meeting people face to face in similar situations would be very uplifting.

    Best of luck to you and keep us posted.
    amaryllis5 replied to bonebabe's response:
    I am 60 years old, post menopausal. I have had 2 bone density scans. In 2007 my numbers were normal for spine and hip, osteopenic for neck. In 2010 my T scores were: spine -2.3, neck -1.9 and hip -1.1. Are these the numbers I should be looking at to judge my bone health? I just started taking Evista because there is breast cancer in my family history. I typically exercise almost every day. Can I increase the density in my spine?
    bonebabe replied to amaryllis5's response:
    If you didn't use HRT right after menopause, I'm guessing that's the reason for the rapid drop in your numbers. Were your scans done at the same place? If not, you really can't compare the two.

    The Evista is good, and yes you can increase your bone density. However, T-scores alone don't determine bone health. The purpose of testing is to ascertain your risk for fracture. At 60, even with a -2.3, your risk is probably low unless you've already had a fracture after age 40, you had a parent who broke a hip or you've had steroid treatment for greater than 3 months.

    Look at the NOF website. . They have a wonderful booklet we use in our rehab classes called "Boning Up on Osteoporosis." It costs $6.50. I suggest you order it. You'll learn lots of good stuff.
    vlbWorrell replied to bonebabe's response:
    Thank you for your reply and good advice. Yes, I have recieved excellent feed back from many wonderful people.

    Actually the loss of the hip was from an accident where a horse fell on me and smashed the ball of my hip joint.

    Luckily the only osteoporosis I have is in my low back, you said Reclast was especially effective for the hips, is it also the best one for the spine.

    Do you have any information about Reclast or any of the other yearly osteo drug and if there is any problems with them and the drugs they use to put you to sleep during surgery? It is possible that it could be a long hip surgery. I am wondering if I shouldn't wait to start osteo drug treatment after surgery.

    I will check out the book and a support group.

    Thank you for your support.
    bonebabe replied to vlbWorrell's response:
    Look at the NOF website. Under patient information, click on "Medications." You should get answers to your questions there. Also on the FAQ section.

    The Reclast is very often given during hip surgery as it is an IV infusion drug. Evista is good for the spine, but it all depends on what your lifestyle is and what your body can tolerate. You may have to try a couple to get a good fit.

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