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    Prolia or Forteo
    An_254879 posted:
    I am 48 yrs 98 lbs and gaining with a low of 93 few months ago and have been on Atelvia for almost 1.5 yrs with my T score getting worse L1-l4 and opstopenia with borderline osteopoosis for other areas... I am also hypothyroid having trouble regulating with mostly being thrown into hyper mode.... I am nervous and unsure which I should choose as to not just slow down the progression but build back up at any extent.. I have been a very active runner now restricted to treadmill/elliptical and kettle balls for weight bearing and cardio. Any encouragement/direction and similar personal experience I would really like to hear. I am not an idle person and have been active in outdoor activities and sports most my life until problems started with my thyroid 2 yrs ago and have progressed to blah! Not depressed just stressed and looking to progress in some forward direction )
    bonebabe responded:
    Are you postmenopausal? Are you on hormone therapy if you've passed menopause? What is your lowest T-score? (Diagnosis is made on lowest site regardless of T-score on other sites.)

    One and a half years is not long enough to measure change in your bone density - and the change is not determined by T-score. It's determined by change in BMD using a formula based on the machine's precision study. Not losing is considered stable. That's what you want. Sometimes an increase is really the result of arthritis - which gives a false positive in testing.

    You are past the time of building new bone. What you need to focus on now is maintaining strength in the bone you have. Your RX, calcium & Vit D consumption along with exercise will do that.

    Are you consuming 1200 mg of calcium daily, taken throughout the day? The body will only process 500-600 mg at a time, so spread yours out. You also need 1000 IU of Vit D.

    If your spine density is low, do not do any exercise that involves bending forward at the spine or side twisting. This can cause the tiny struts within the vertebra to break. When the last one breaks, you have a compression fracture. You will not feel any of these breaks until your vertebra collapse. There is no going back from that point.

    Not sure about the kettle balls. We advise our osteoporotic patients not to lift over 10 lbs. This can put added pressure on vulnerable vertebrae.

    Check out the National Osteoporosis Foundation website - for a lot of good information. They have a great FAQ section.
    gmatkins replied to bonebabe's response:
    Thank you for all the info. I am perimenopause...not on any hormones. I do take thyroid meds, vitd3 5000iu and yes I take 1300 calcium in supp form aside from my diet divided up daily.
    The change in my BMD is -1.8%. Lowest t-score -3.1 at the L1, -2.8 at the L4 . My hips are at -1.1 with BMD change of .2% and my neck t-score was -1.7 with BMD of .665
    My vit D level was 54 last it was checked. Both primary care/gyn and endocrinologist are agreeable to the prolia choice. I am just unsure and would like to know what I can do if more and how to measure progress other than waiting so long to see if tx is even working and is this time frame normal? Thanks again for your input and the referral to the website. Any info is appreciated much.
    bonebabe replied to gmatkins's response:
    If you are perimenopausal, you can expect your T-scores to drop as you go through menopause. When you have been one year without a period, you will be postmenopausal.

    Why are you taking 5000 IU of Vit D? Especially when your levels are fine? That is waaaay too much unless it is RX Vit D.

    I'm not understanding the reporting of change in your BMD. It is not generally done in %. What is the lowest number your testing center says is considered significant change? In other words how low a change can you go until it's not a change? Ask for the lowest significant change and you should get a number like 0.029. That means any change lower than that number is no change or stable.

    If both your doctors are in agreement with the Prolia, then do it. Your numbers are too low, as is your weight and perimenopausal status for you to play around with no meds. Your spine numbers are not looked at individually but in an average, usually L1-L4. When you say your hips, I'm assuming you're referring to your total hip number? If that's -1.1 and your femoral neck is -1.7, you look at the -1.7, especially since the femoral neck is where hip fractures mostly occur.

    The reason scanning more frequently than every two years is done is because bone is very slow to respond to change. You wouldn't get an accurate picture of your bone health were you to have it done annually. The only way to tell if treatment is working is to have the scan done every two years at the same place and compare them. If your BMD has increased significantly or is stable, the meds are working.

    Get familiar with the NOF website and order the booklet "Boning Up on Osteoporosis." I certainly wish you good health. I wish more of our patients were as vested in their bone health as you are.

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