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Osteoporosis Message Board

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[QUOTE=Nan-NMW]I am reading "What Your Doctor May Not Tell You About Ostyeoporosis" by Felicia Cosman, M.D., which was recommended by someone on this board. In the book she makes a very good point about the fact that once you stop taking Forteo, you need to start taking Fosomax or some other bone building drug or you will lose the bone mass you have gained from the Forteo. ... I am doing all of this research before agreeing to start Forteo, as prescribed by my doctor. However, what happens if after taking the Forteo for 1-2 years, and spending the small fortune that this drug costs, and hoping against hope to not develop bone cancer, you find that you cannot tolerate the Fosomax, etc. ... I just had the DEXA scan two weeks ago and have not previously taken any osteoporosis meds. I am thinking that it might be wise to try the drugs usually prescribed for less severe cases than mine first to be certain that I can take them forever after the Forteo. ... I am going to doctor next week for the 24 hour urine and parathroid tests before making any decisions. ...[/QUOTE]

I wrote a lengthy reply very early this morning ... and much to my chagrin just as I tried to submit the reply the site went down for some maintenance work.
:rolleyes: :bouncing:
We start losing bone mass with small "holes" appearing in our bones so that on cross section they look like a sponge. Then the bone mass between these "holes" begins to weaken as well. As it has been explained to me: the bisphosphonates [Actonel, Fosamax, pamidronate (Aredia) and zolendronate (Zometa)] strengthen the "walls" left between the "holes" whilst Forteo (and the still experimental Preos) increase the bone mass by "filling in" these "holes". The bisphosphonates slow the natural dying of bone cells, whilst Forteo and Preos increase the natural bone growth that has slowed down with age.

It is reported that the use of the bisphosphonates PRIOR to the use of Forteo slows down the response rate to Forteo. Its better to "fill in" the bones first, and then strengthen the bone that is there to put it in simplest terms. If one can't tolerate the oral bisphosphonates there is still the option of the bisphosphonates: Zometa (zolendronate) or Aredia (pamidronate) and thus avoid the digestive problems or damage. So there is an option after the two years of Forteo.

Regarding the bone cancer risk: the damage or risk from Forteo has occurred when it has been used PRIOR to the "growth plates" (for lack of a better term) having closed. Thus it should not be used in younger people whose bones are still growing. Rats' bones continue growing throughout their entire life. Ours do not. We've reached our bone growing peak prior to or about our 30's as I remember it. (This is all from memory off the top of my head). The rats were on Forteo their entire life cycle from their infancy to old age death. That is why they developed the bone cancer. After thoroughly reading the rat studies with Forteo I decided I was comfortable taking it as I didn't have any of the risk factors cited for excluding Forteo therapy such as a prior cancer, etc.

My local Endocrinologist, who is associated with a geriatrics practice and has a special interest in osteoporosis, prefers that I have the 24 hour urine test (done) and the parathyroid hormone intact w/ionized calcium, vitamin D 25 hydroxy (NOT vitamin D 1, 25 hydroxy) and serum calcium blood draws prior to initiating the Forteo or pamidronate therapy for my osteoporosis. Whilst my levels, except for elevated ionized calcium, were w/in normal reference ranges she insists that my PTH level be below 30 (normal reference range 10-65 at our lab) and my vitamin D 25 hydroxy levels higher (normal reference range 10-68 at our lab) but I've forgotten what level she wants it at prior to starting either Forteo or pamidronate. To achieve this she is treating me for osteomalacia with 100,000 IU of vitamin D in capsule form once a week.

Nan, you are the first person considering or taking Forteo I have encountered whose doctor has insisted on these same blood draws before initiating Forteo therapy. I hope you discuss this with your doctor and get some more information about this to share with us!

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