I have a friend on Evista, and she has been very happy with it. For a number of reasons, it is not something that I feel comfortable taking, but it seems to be a good option for some.
Did you do Evista instead of Tamoxifen? I am post-menopausal so I did an aromatase inhibitor, which stops all estrogen in the body. Caused a dip in bone density similiar to the one at menopause, about 10%. Tamoxifen and Evista don’t stop estrogen production but affect certain receptors, but bones continue to benefit from estrogen. I have atrial fibrillation so docs don’t want me on these meds, but if I cannot take Tymlos I might ask again.
Doctors don’t mention Vitamin K but it appears constantly in forums. Here is one study:
“Main Message
Vitamin K2 may be a useful adjunct for the treatment of osteoporosis, along with vitamin D and calcium, rivaling bisphosphonate therapy without toxicity. It may also significantly reduce morbidity and mortality in cardiovascular health by reducing vascular calcification. Vitamin K2 appears promising in the areas of diabetes, cancer, and osteoarthritis. Vitamin K use in warfarin therapy is safe and may improve INR control, although a dosage adjustment is required.”
“Vitamin K2 in the form of MK-7 is rapidly becoming popular as a supplement and is available OTC usually with a dose of 100–120 μgm. It is important as physicians to be aware that MK-7 can interfere with anticoagulation therapy when used above 50 μgm/day [48].”
Info on CBC markers for osteoporosis- from the Inspire National Osteoporosis Fdn. forum:
If you are familiar with my book, The Whole-Body Approach to Osteoporosis, you know how important lab tests are for assessing, managing, and improving bone health. Today I would like to talk about indices in the CBC (Complete Blood Count) that give us valuable information about the skeleton.
When we think about CBCs (I know…who but me sits around thinking about lab tests on New Year’s Day!?!) we think about testing for anemia, infections, and blood clotting issues. But CBCs can also tell us something about the quality and strength of bone.
Specifically, when looking for clues about skeletal health within the indices of the CBC, I like to look at the following 6 markers:
RBC count (red blood cells)
MPV (mean platelet volume)
NLR (neutrophil lymphocyte ratio)
RDW (red cell distribution width)
Hgb (hemoglobin)
MCV (mean corpuscular volume)
RBC count: When the red blood cell count is even slightly low it may indicate an accumulation of fat cells within the bone marrow. An excessive number of fat cells not only crowds out RBC-forming stem cells (hematopoietic stem cells), but also leads to an increase in the level of PPAR- gamma, a protein that stimulates the osteoclasts to break down bone. In addition, a low RBC count may indicate a reduced number of bone-forming osteoblast cells because osteoblasts play a central role in hematopoiesis by releasing red blood cell growth factors.
MPV: Elevated MPV is an early marker for platelet cell activation seen in low-grade inflammation. It is low-grade chronic systemic inflammation that is the main fuel behind all chronic disease, including osteoporosis.
NLR: An elevated neutrophil to lymphocyte ratio is an indicator of chronic systemic inflammation and is negatively associated with bone mineral density. NLR greater than 2.5 is correlated to low bone density.
RDW: The size of red blood cells becomes more variable with age and the RDW is an indication of this variability. An RDW greater than 15% carries a greater risk for fracture. (Kim, K.M., et al. 2019 ASBMR Ann Meeting Abstracts, #1069)
Hgb: Abnormal hemoglobin levels can indicate too much or too little iron in the body. This can impact skeletal health by increasing osteoclastic activity, leading to bone loss.
MCV: This is a measure of the average size of red blood cells. When elevated, it may indicate a deficiency in vitamin B-12 and/or folate. Pernicious anemia is a condition that reduces the absorption of vitamin B-12 and calcium. Vitamin B-12 has a direct influence on osteoblastic bone-building activity. An elevated MCV is a flag to look at homocysteine, a protein metabolite that contributes to chronic systemic inflammation and reduced bone quality.
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^^^ Interesting. My latest blood work includes all those measures but MPV.
I also have everything but MPV in my results (although I had to do some ciphering to get NLR). I appreciate this information, and I am happy to see that my numbers are all good.
The osteoporosis forum today has someone really upset at osteopenia with bone densities of -1.7 and -1.8 and so on. The medical establishment is scaring people unnecessarily and meds are being given prematurely.
I think of it this way. We can take Forteo or Tymlos for two years in our lifetime. Then we can take biphosphanates or Prolia for 5. So when is the magic moment when we should start meds? Fracture risk just isn’t as great as they say until you get much lower bone densities (even at -3.4 I would not have fractured if I hadn’t done a ridiculous and unusual movement and I have made it 14 years without a fracture)>
I am going to start Tymlos and will be 77 when I finish the two years plus 5. What if I had done meds when first diagnosed at 55? I guess we could all do Evista but there is a blood clot risk. Where does the medication path end?
For early osteoporosis, I am just glad to read that folks on here are focusing on diet and exercise and supplements. And you don’t have to be so violent about exercise 
Tai Chi is an excellent approach and gentler too . Or walking. I have seen studies that question the whole weight- bearing thing (cannot cite or remember) so all the research everyone here is doing is great.
These fractures hurt! I carried groceries in one by one yesterday. I like living alone but right now it has its problems. But I know they will heal in 2-3 months and I have hope for the future even in my more dire shape w/osteoporosis. So take heart!
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Violent about exercise?? Are you talking about the stomping/heel slamming?
I was just kidding. I was thinking of a friend who characterized the exercise class at my mother’s assisted living as “violent,” as opposed to chair yoga and tai chi. We have the idea that exercise is only beneficial if fast, hard, heavy and so on. But my comment was kind of light-hearted and meant to encourage those who, like me, cannot do more vigorous gym type exercise.
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I was envisioning running when I read your comment. I used to run, and it was hard for me to stop when my body told me I had to. This was long before osteopenia set in. Because I couldn’t believe walking could possibly be beneficial (yup, I was a running snob), I didn’t replace running with walking. Fast forward to recent years, and I not only walk daily … but I have definitely found it to be beneficial. You couldn’t have convinced 40 year old me, though!
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You have got me really curious – what sort of contortions did you do?
I wish I lived close enough to you to help you carry in your groceries! (I think we are on opposite coasts??) It would be gread exercise for me.
Thanks for the info about CBC’s – my doctor hasn’t ordered a CBC since 2018 – when I dug through my old reports on Quest I can see that my numbers then were all quite normal, so I don’t fault my doctor for not repeating the test – but I’ll remember to ask for it the next time around.
I want to thank you for the other info you have posted as well, because after I met with the rheumatologist I realized that he had more detailed reports in hand than the summary reports I had been given. The doctor couldn’t print out the reports for me, but it turned out to be easier than I anticipated to get them from the radiology lab — so now that I have those in hand, with the pictures of the scans and colored charts, I’m feeling relieved. I can see that my numbers are right at the line beteen osteoporosis & osteopoenia – and of course I also now understanding that -2.5 line is arbitrary. So I have time.
I have been taking MK7 for the past 2 years - I take 180mcg daily. I have no idea whether it helps or not, but it certainly doesn’t hurt – the dosage is just what was used in one of the studies I read.
haha that would be a great combo- you doing weight-bearing exercise and me avoiding it!
I’ll PM the movement I did because it is a little embarrassing.
I get a CBC done annually as part of my wellness exam. The best part is that it is free to me (as in, even before I hit my ridiculously high deductible on my high deductible plan). A perk of the Affordable Care Act!
For exercise guidelines, I recommend Margaret Martin Physical Therapy for Prevention and Treatment of Osteoporosis (melioguide.com)
Her book 'Exercise for Better Bones" is invaluable, as are her free courses online, blog, Facebook and video.
With fractures, I am finding that doctors are not terribly helpful. This feeling was somewhat validated by some of the comments I have seen on forums. The hardest part is the first 8 weeks when pain is bad but can’t start PT yet. I just want to know if a short walk is okay and noone can tell me. I am getting good at the “log roll” out of bed and avoiding bending or twisting. But can I take a walk? I think that noone wants to be responsible/liable. So I just put on my new brace and took a 4 block stroll in the sun, which apparently has not crippled me 
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Maybe that is part of their point - you have to listen to your own body and move at your discretion.
Doctors aren’t perfect. They also can’t feel your personal pain. They can and will help you clinically but you are part of your own treatment plan by also knowing when you’ve done, and knowing what your body will allow you to do.
Remember that many of those journal articles your read and seem to gather info from…are written often by doctors or medical researchers
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Of course doctors aren’t perfect. I am just saying they literally refuse to advise. PT will be helpful at some point.
I have long experience with medical professionals, believe me. Sometimes in the role of preventing harm, and sometimes very appreciative.
This is akin to the obstetrician who doesn’t know much about diet. Doctors are just very siloed.
Not sure why you took this as naive criticism of MD’s.
My chiro said the most helpful thing: if you move wrong, you can make this worse.
Going back to dealing with this privately.
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I also find my chiropractor to be much more helpful in terms of practical advice. Their whole practice is built around helping people with various types of back pain, and their focus is helping with the pain and trying to restore function. So yes, your chiro’s advice was vague… but I’d take it as a suggestion to take things slowly and to be careful. If you were able to walk four blocks while wearing a brace, that’s great. Just don’t push yourself and give yourself time to heal.
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I am not relying on chiro either. The chiro I talked with was Keith McCormick, the osteoporosis guru. After some weeks of solitude with this and finding what works myself, I will consult a physiatrist/rehab medicine/pain specialist and or PT. All good. Just when I was going to be vaccinated and cut down on Netflix!
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Netflix helps healing.
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