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Posts Tagged ‘Forteo’

I was told last week about the mother of an acquaintance in Chicago.  His mother has had Vertebral Fractures again and again and again.  After each fracture she has been told that nothing can be done to prevent another vertebral fracture.  She is turning into a pretzel as her spine crumbles.

After 2 vertebral fractures, she is odds on favorite to fracture another vertebra within the year.  She is also unlikely to respond well to an antiresorptive such as Fosamax, Actonel, Boniva, Reclast, Prolia or their generics because of her severe osteoporosis.  Game over?  Not at all.

Multiple vertebral fractures make her an ideal candidate for an anabolic medication.  Forteo (2002), Tymlos (2017), and Evenity (2019) all can salvage her bone health and increase her bone matrix by 20% or more.  I recommended she see someone up to date in the options available.  There are several in Chicago.  And several here in Iowa.

She needs a Complete Bone Health Evaluation and anabolic treatment.  Of course that includes enough absorbable calcium, enough Vitamin D3, and other nutrition.  Anabolic medications specifically require enough protein to work because they build new bone matrix, which is collagen, which is protein.

You don’t have to fracture again and again.  We can help.

Jay Ginther, MD

If you fracture, your risk of a second fracture within a year is 3 to 5 times as great!  If that first or second fracture is a hip, you have a 25% chance of dying and a 25% chance of spending the rest of your life in a nursing home.  Scary.

Sometimes nutrition and lifestyle changes are enough.  Often medications are needed to effect real improvement.  The anabolic medications Teriparatide (Forteo), Abaloparatide (Tymlos), and Romosozumab (Evenity) not only prevent further fractures by increasing bone mass, but also speed healing.  The antiresorptive medications decrease fracture risk by preventing bone loss.

The NOF video at https://vimeo.com/267839997 discusses the likelihood of benefit in relation to the very small risk of harm from antiresorptive medications.

Understand the relative risks of taking a medication compared to the relative risks involved in not taking a medication.

Jay Ginther, MD

Covid-19 is quite contagious.  Patients coming into a clinic or hospital could put themselves at risk from other patients.  Patients who are not yet symptomatic can put other patients and health-care workers at risk.  How can we get essential medications, yet limit risk?  Drive-Thru.

I am on several medications which cannot be stopped because I am controlling chronic diseases (that cannot be cured).  I no longer enter my pharmacy.  Drive-Thru window.

Osteoporosis is a chronic disease we cannot cure, but can control.  We now call every Prolia and Evenity patient offering the option of being met in the parking lot.

Roll down the car window.  Roll up your sleeve and put your arm out the window.  Get your shot.  Roll up your sleeve and window.  Done with minimal exposure to another person.

Remember that skipping a Prolia shot is a very bad idea.  Recently evidence has surfaced that missing a Prolia shot by more than 2 months can increase the risk of vertebral fracture to higher than it was before starting treatment.

Most of the time we can delay the DXA/VFA or lab tests by a month or 2 or even 6.  Prolia and Evenity should not be delayed.  Forteo and Tymlos usually arrive by mail for self injection.  Changing to a different medication could be another option.  Call your doc.

Jay Ginther, MD

Improve Bone First – Preserve Bone Second

December 8, 2019 @ 8:19 pm
posted by Dr Ginther

National Bone Health treatment goals are changing for those patients with high fracture risk.  Simply preserving bones already at a too high fracture risk never made much sense to this former orthopedic surgeon.  Now the national leadership is stressing the need to lower fracture risk first, then preserve bones at a lower level of fracture risk.

We now have 3 anabolic medications which substantially lower fracture risk by increasing the thickness and strength of bone structure: Teriparatide (Forteo), Abaloparitide (Tymlos), and Romosozumab (Evenity).  They all decrease fracture risk substantially more than the antiresorptive (preserving) medications alone.  The difference in fracture risk grows for up to 5 years.  After that the difference in fracture risk between anabolic meds followed by preserving meds vs. preserving meds alone remains the same.

Calcium can take up to 3 additional years to collect in newly formed bone matrix.  DXA shows calcium in bone (Bone Mineral Density).   Much of the increased BMD can only be seen on DXA after the anabolic med is completed and the antiresorptive med is started.

All of the anabolic medications must be followed by antiresorptive medication to preserve the gains made by the anabolic.  No medication to grow or preserve bone can work without adequate nutrition in the form of absorbable calcium, vitamin D3, protein and other vitamins and minerals.

Jay Ginther, MD