Osteoporosis...t score -3.4.......what meds to take.

Thank you Ros. All the best to you too.

In Australia there are only three, namely Prolia, Actonel and fosamax. I have been advised against Prolia because I will have teeth to be extracted in the future and it is problematic. My choice would have been Prolia because it is only six monthly and no need to swallow. My GP sent me away to research and think which I have done. Fosamax is the choice but how to take it is now the question. 

I have to wait for another appointment for an IV, not sure which drug it is yet. Been in hospital recently and had to cancel my appointment. Due to health problems I am not able to take tablet form of drug, as it is too dangerous.

A special chemist compounds the tablets into liquid at a cost. As I got another tablet caught last night I think I will have to accept the cost and have the liquid form of fosamax.

Kathleen Hi,  I'm a bit confused here. I thought you posted that you have had your dental work completed recently (is there another Kathleen?). If you haven't, I would WAIT until you have before taking any of the standard meds. for OP (Fosamax, Actonel, Prolia). A few months delay may make no difference to your bones but having dental work - especially extractions- could cause problems.  . . .Many a person has to have dental work done when they've been taking bishosphonates for years. You have a choice here and could get any major work done before starting medication and then be in the clear.  Do discuss this with your Rheumatologist. Kind regards,

The dental work needed now is complete but there is definitely more to come. I have several vulnerable teeth. My husband suggested I have all my teeth out now but I feel that is a bit drastic. I am just waiting for the mouth to fully heal before beginning the fosamax. I have had two pills caught this week so I think to be safe I will have the fosamax compounded into liquid. 

Any dental work in the next three years is doable. After that I will have the CTX test to check level and go off the fosamax if necessary in order to have teeth extracted. So, it is all manageable!

Kathleen, I'm reluctant to be a wet blanket, but the big problem with Fosamax and the other bisphosphonates is that one can't just go on and off them and by doing so assume that they are no longer exerting an effect. The bisphosphonates have a staggeringly long half-life -- up to ten years, by some estimates. Therefore, dental work could be affected for a very long time. Which is not to say that it will; apparently the majority of people who take these meds do not run into dental complications. But the number who do is significant enough that FDA in the U.S. has made changes in its guidelines as to who should take these drugs and for how long. My suspicion, admittedly a personal one, is that the rates of complications for bisphosphonates has been underreported and restrictions on their use will continue to grow.

I do understand how scary taking fosamax is. It is not only the dental issues but there are other side effects too. That is why I am taking so long to weigh up the pros and cons. Allison, can you state your t score please.

Hi Kathleen, Allison is right when she says that meds like Fosamax  stay in the system for long after you've stopped taking them. Prolia, and Forsteo don't but may not be suitable, You sound like you have a vulnerable dental situation ( heavy work done, some more to do ) and if I were you I'd maybe consider a second opinion about what is best to do. It's alright for your doc to "send you away to do some research" but isn't that what you're paying him for ie. an expert opinion??  Anyway, don't panic. Finally, is it a GP or a Rheumatologist that you see?  Take care.

My GP is not an expert. I have not seen a specialist about this. I think we have to research this one because the side effects are much more than other medications. The oral surgeon was knowledgable and my GP is passing that CTX information along to other doctors. My sister seems to have started the fosamax without any concerns and her t score is only 2.8 which is under the 3 and she is 74. She knows other people on fosamax and that is what she went on. She believes it to be safe but she did no research. I think a broken back for me is not an option so I will probably take fosamax in liquid form and exercise in the warm water pool.

Mine is less for hip but more for spine than yours. Do you do something to help like exercises? I am guessing you have decided not to take the meds.  Has your osteoporosis gotten worse over time?

I've been doing very modest exercising for the last six years, consisting of treadmill and weights on a Universal machine, but only once a week. I'm not motivated to exercise more often because, from what I've read, I'm not convinced that once the diagnosis is osteoporosis, exercise makes much difference. I won't know whether the osteoporosis has progressed until and unless I have another bone-mass-density test. It did worsen, over about eight years, in terms of going from osteopenia to osteoporosis. Over the last couple of years, I've stopped taking several medications that some studies have linked to bone loss, most notably, proton-pump inhibitors (PPIs), widely taken for GERD. Doctors encouraged me to take them for nearly 20 years; now, long-term use is regarded as potentially dangerous. I also had low Vitamin B2 and D levels, which may or may not have any bearing on bone loss. And I had a hysterectomy, which is notorious for contributing to bone loss, 15 years ago. I do not downplay in the least the risk of fracture, whether due to osteoporosis or some other cause, especially having spent the last few months recovering from a wrist fracture that I sustained from a slip on ice. No doubt that a hip fracture would be many times more painful and debilitating than the wrist fracture, which was bad enough. However, I don't subscribe to the belief that every real threat has a solution. The osteoporosis meds strike me as so potentially dangerous that I don't consider their risk acceptable, at least, not so far. Conceivably, I could change my mind at some point. Meanwhile, I am hoping that better osteoporosis meds are in the pipeline.

That all sounds very reasonable to me. I have never seen such scary risks associated with medication. That is the reason I have investigated it so thoroughly. My GP knows this too because she sent me away to think about it and do my own research. The thought of breaking my back scares me too. I am using a rollator because of vertigo and to give me confidence to walk. The vertigo is much improved but I still have some dizziness. I think people with bad osteoporosis should be using a walking aide to ensure there are no falls. It also warns other people not to cause you to fall. 

Hi Allison, as far as I know, the benefits of exercise for someone with OP are that it MAY contribute to increased bone density but also, more importantly, regular exercising helps maintain and hone our ability to maintain balance - it seems we become more unstable as we age. Balance is SO important because, as you just said, it's all about not falling. No falls, no fractures (mostly). As for exercise, it is healthy in so many ways anyway. I walk a modest 35mins. during the week and, for my sins do dancing (!) one day (1 hour). The latter great fun and my skills here have now progressed from 'very poor' to 'poor' . . . but I have high hopes !!  Take care,