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Forteo in Premenopausal Women
An_224026 posted:
I am 34 and just had a DEXA Scan and was told my left forearm has a t-score of -4.1 and the lumbar spine t-score is -4.1. I saw a doctor who recommended Forteo, however insurance said they would not cover it because I am premenopausal. First of all, how bad is -4.1, what should the score be?
Second, if I do take Forteo, the internet says it can only be used for 2 years, is there an optimal time to use it? Also why can't you use it more than 2 years?
Lastly, how much is Forteo? Also if I wanted to find an "expert" how would I? I looked on the OSTEO foundation website and did not see any doctors listed near me, even in my state. I am in a rural area where we have an endrochronologist however he has not treated osteo in a premenopausal women.
Thank you all for your help!!!
bonebabe responded:
There have been some good posts on the subject of premenopausal on this board. Look at some of them, particularly by Susan Allison for some information.

First of all, if you're premenopausal, you should be looking at Z-scores, not T-scores. And there is no diagnosis given to premenopausal women. However, with a score as low as -4.1, your Z-score won't be much higher. This is a pretty significantly low number. Osteoporosis is defined as having a T-score at -2.5 or lower.

Secondly, did your doctor say anything about testing you to find the cause of this? The endo would be a good start. Also if he could find a reason for your low bone density (osteoporosis as secondary) your insurance company might be more inclined to pay for treatment.

Look at the ISCD (International Society of Clinical Densitometrists) website ( ) to find an expert near you. It may take some navigating the website, but that info is there.

As for the Forteo, no testing has been done on its effectiveness past 2 years. After the 2 years of treatment, you would followup with a bisphosphanate like Actonel, Fosamax, Reclast to strengthen the new bone. As far as I know, there's no optimal time to take it. You do it when you find out you're at high risk of fracture.

Have you been on a medication like prednisone or antiseizure meds for an extended period of time? That really depletes your bone density. What about anorexia? Have your periods been regular? Have you been checked for a Vit D deficiency? What about your parathyroid? Do you have an inflammatory illness like Crohns or IBS? Have you had gastric bypass surgery? All those things play a part in your bone density.

Eli Lily manufactures Forteo and they have a program to help with the cost of the drug if you need it. Look at their website and contact them. Be sure to say you're premenopausal and your insurance company is balking. They may be more likely to help in that situation.

In the meantime, do not bend forward from the waist and no twisting of the spine. Order the booklet "Boning Up on Osteoporosis" from NOF asap. It has good illustrations of Do and Don't Do movements. Also consume 1200 mg of calcium each day. Your body only absorbs about 500-600 at a time, so spread it out. You also need 1000 IU of Vit D. This can be taken at any time.

Good luck to you.
04131971 replied to bonebabe's response:
I am 40 years old and have a T-score of -2.7 the doctor wants me to take Forteo because he said it could reverse the osteoporosis i am nervous about having to take this for two years and then take another kind of shoot every 6 months for the rest of my life
bonebabe replied to 04131971's response:
Are you premenopausal? If so, you can anticipate your T-score going lower as your body ceases its estrogen production. I'd also be curious to know if the doctor has run any tests on you to determine the cause of your low bone density. If it's simply because you didn't build up your peak bone mass during your bone forming years, the Forteo could, indeed, reverse or at least significantly improve, those numbers.

After the treatment course for Forteo, you do have to strengthen the new bone growth with a bisphosphanate. This could be Fosamax, Boniva, Reclast or Actonel. You could do the Prolia, but that's not your only choice. And it not necessarily for life.

The goal is to reduce your risk of fracturing. T-score is only part of that picture. Family history, fracture history, medication history all play a part. If you're at a high risk, then you'll most likely take the meds longer. If the Forteo improves your T-score and your other risks are low, you might not have to be on another med very long. It would depend on your test results showing you're stable.

There are a lot of variables in your situation. I wouldn't just reach for the Forteo unless you're at an extremely high risk of fracture. This would be determined mainly by the presence of prior non-traumatic fractures in the last couple of years, the use of prednisone for greater than 3 months or antiseizure medications, and whether you're postmenopausal. If none of those things apply to you, I'd ask for a Vitamin D check and talk about Reclast, Actonel or Fosamax instead of Forteo.

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