Finished Forteo – Now What?
Aunt Henrietta finished her 2 years of the Anabolic, Forteo. It worked. Just to prove it, she fell all the way down the stairs and didn’t break anything. What osteoporosis medication should she take next?
The FDA specifically does not allow persons marketing Forteo to recommend any other medication to follow Forteo because no prospective, blinded, randomized trial involving at least hundreds of individuals switching to one specific medication has been done. A separate trial would be needed for each Antiresorptive medication.
Forteo must be followed by an Antiresorptive medication in order to preserve the gains achieved by increased bone matrix formation. Determining the best medication for each individual requires a full osteoporosis evaluation.
Aunt Henrietta has major problems with GERD which require Nexium daily. That makes all Oral Bisphosphonates potentially dangerous.
She also, like many others in their 80’s, has tired kidneys. IV Reclast can be dangerous for someone with failing kidneys. I use a GFR (a measure of kidney function) of 45 as a cut-off. In patients over 70 this must be calculated individually taking into account age, weight and Creatinine. Henrietta scored less than 45.
Aunt Henrietta was a good candidate for Prolia. It is the only medication causing no problems with GERD and aging kidneys. I discussed this relatively new medication with her Endocrinologist. Next time we will cover the one extra consideration before she actually started her Prolia.
Remember that every individual is different. You need a full bone health evaluation, and a full discussion with your doctor, before deciding which Antiresorptive will be best for you after Forteo.
Jay Ginther, MD