I mean it’s a Catch 22! I have been doing the things I CAN do for a few years - weight bearing exercise daily, some weights, calcium/d, green leafy vegetables…but the #'s are the #'s and while one has slightly improved overall they aren’t stellar. Broken bones from a fall as I age scare me! It feels like “choose your poison”. 
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As probably anyone who “knows” me here, my mom fell over the holidays. She had never gone on osteoporosis medication and she broke a few bones she probably shouldn’t have. It was quite scary.
I have been thinner than my mom and I’m very fine boned. I was taking vitamin D and weight bearing exercises for a long time. But added the calcium after my first bone scan 2 years ago. Through trial and error, found that I can only tolerate viactiv calcium supplements.
I also have pretty bad TMJ and some arthritis in my jaw. I’d really rather not go on fosamax.
Thanks for the info. And glad I nudged you @abasket to make that appointment!
What did your dentist have to say? I am hesitant to start meds as well.
She is concerned about jawbone problems (necrosis). The other issue is that typical procedures for root canals and tooth extraction can be negatively impacted due to use of osteoporosis drugs. That hit home for me, because I broke a tooth from nighttime tooth grinding (even with a bite guard). It was broken completely in half but was still firmly in place in my gums. The oral surgery was no picnic, but it would have been a real problem had I been on osteoporosis drugs.
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Yeah I think what makes it less of an issue for me is that i am not fine-boned, and again, the weight here, if no where else, really does help. My mom slipped on ice when she was 75, broke her wrist, but think that might have happened regardless. Never broke another bone after and she lived till 89.
I had the same thing happen. Broke a molar right in half. Even with my mouth guard.
I can’t wait for the Michigan meetup - we seem to have a lot in common! 
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Unfortunately, the first line of treatment, often offered by PCP’s, even with “just” josteopenia, is the anti-resorptive Fosamax or other bisphosphonates. Both bisphosphonates and Prolia actually may interfere with the effectiveness of later stronger bone building drugs, Forteo, Tymlos and Evenity. Insurance covers the anti-resorptives first, which needs to change. The sequence should be reversed.
Anti-resportives like bisphosphonates, Prolia and to a lesser extent Evenity, are the ones that affect dental and jaw issues. However jaw necrosis is very rare and mostly cancer patients on much higher doses. Of course there are exceptions as with any side effect.
I am a frequent poster on osteoporosis forums. I tried to get on meds for years. I even saw an immunologist to try to get on Forteo. I had breast cancer and was on an aromatase inhibitor, which eliminates estrogen in the body, and had even worse osteoporosis. My doc didn’t put me on Reclast, which is usually given during cancer treatment, due to afib concerns.
I was about to try Tymlos in early 2020 when COVID hit, and was afraid of going to the ER if the med triggered afib. (As it turned out when I did start at the full dose, I did end up in the ER, in summer 2021.)
I had fractured vertebrae from a traumatic fall. But in spring 2021, I made an unwise movement and fracture one thoracic and two lumbar vertebrae. I live alone and could not function, cook, do laundry. The pain was so bad I would end up on the floor, crawling. I repeat: this was from one unwise movement.
I had no symptoms before this fracture, and was doing martial arts and sword tai chi. I was walking miles each day. There is no way to know if this is going to happen, once bone density scores reach a certain point, probably around -3.5 for me.
So I have two seemingly contradictory messages. One, I think MD’s are still medicating too early, with osteopenia or even early osteoporosis. And two, don’t wait too long for the stronger meds if you do need medication- and find a way to do them first.
Another thing to think about it time and what you do after one med to follow up. Anti-resportives carry risks of jaw necrosis and atypical femur fractures if used too long. So then what do you do. And If you start with a bone builder, what are you going to do afterward to lock in the gains? When you stop meds, you lose gains unless you “lock in” with an anti-resorptive, usually Reclast. You might be able to take a break after a bone builder, then Reclast, with monitoring. But at some point we run out of time so starting too early leaves you in a difficult situation.
If you want a bone builder, and your scores are low enough, doctors can advocate for the stronger meds or your can “try” two and “fail” and get insurance. Forteo and Tymlos have coupons for pre-Medicare and patient assistance programs. I got Tymlos for free.
I tolerated 6/8-7/8 of the full dose of 8 clicks of Tymlos and still had those tremendous gains. I started at 2 clicks and moved up. Forteo is only full dose.
Keith McCormick has a new book out entitled “Great Bones.” It is almost 700 pages and I read the whole thing and recommend it!
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Just had a consult with McCormick. The challenge is to get docs to do what we want! I know what I want as a plan going forward but I need my endo to cooperate 
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Thanks for the book recommendation. About a year ago I had the scan that pushed my osteopenia into osteoporosis. I was on Fosamax, and then off as I started having odd pains in joints and muscles. An acute knee injury scared me, and I stopped the Fosamax till that resolved. Now I am back again on Fosamax, cautiously, but watching for those odd pains which haven’t returned. Prescribed by my primary, I am wondering if I should move on to an endocrinologist.
My mom and aunts had terrible osteoporosis, as do cousins. I am not a tiny person, lift heavy weights above my head most days, have titrated Vit D levels up, walk for miles at a good pace and eat my greens and dairy products. I didn’t take calcium for all the reasons given to avoid it, but have now started. So I was hoping to avoid this diagnosis. Wrong.
@great_lakes_mom I would definitely see an endocrinologist.
Putting my 2 cents in FOR seeing an endocrinologist. I had my first appt today after being told I had osteo about 8 years ago and putting off doing meds.
My last 2 primary care docs and one ob-gyn previously just wanted to prescribe and move on. They offered little explanation. Maybe not their fault - as they just may not have the indepth info I was looking for to share with me. I finally got a referral to an endo and went today.
SO much better info. Nicely in-depth and thorough. No doubt my numbers aren’t good. And I’m starting to recognize the possible complications of getting older and falling/fracturing. While all the meds have some risks they really are quite low and often are with people who have other health concerns (I’m a clean bill of health other than this and exercise regularly, eat pretty well).
I’ve been taking calcium and D. Doc ordered blood work to check my calcium and D levels because he thinks I may be taking too much (no one over the last 8 years has questioned that!). I’ll also have x-rays to be sure that I haven’t had any previous (unknown) fractures.
I’m going to start Prolia. With my numbers (my spine being the worst) he felt this was best - one shot every 6 months. Then possible “maintenance drugs” after that of something like a Fosomax - we will see.
I’m not looking for any horror stories or opinions on Prolia… you can share an experience if you like…but after 8 years of waiting and another bday rolling around this fall, it’s time for me to do SOMETHING!
I really like both the endo and the endo fellow(ship) I saw. Great info verbally, good review of my past 3 dexa scans, balance test in the office, etc.
Onward!! And hopefully on FEET without falling!!
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I had a wonderful endo also-- unfortunately she retired, and now my PCP follows me. The endo put me on Prolia for about three years. Last year, my PCP thought I was doing so well that we could stop the Prolia for a while. Then, I saw a new rheumatologist who scared me by telling me that once you stop Prolia, your scores can plummet. So, I just had another bone density today, after only one year, to see how I’m doing.
But I support the fact that endos are the best doctors for osteoporosis.
My doctor described that time after Prolia as something like “holiday maintenance” - that you would break from Prolia but maybe do Fosamax to keep the numbers maintained. Something like that!
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I strongly recommend Keith McCormick’s book “Great Bones” (700 pages) and Ben Leder MD’s video on Combination and Sequential Treatment of Osteoporosis. I have seen two endos over the 16 years I have had osteoporosis, one of them chief of endo at a top hospital. None of these experts use Prolia unless they absolutely have to. Mainly because of the plummeting of bone density and increase in fracture risk. Check Dr. McCormick’s explanation of the complexity of switching to Fosamax (more likely to be infused Reclast to be strong enough to combat the plummeting). The standard timing is 6 months but monitoring needs to be done so that the switch is not too early, in which case the Reclast may not work, or too late, in which case density has already been lost.
Understand that Prolia is an anti-resorptive that may interfere with the effectiveness of the bone building drugs if needed afterward: Tymlos, Forteo and Evenity( Evenity is both bone building and anti-resorptive).
If you use an anti-resorptive too long, bones become more brittle. There is more risk of jaw necrosis and atypical femur fracture. Prolia, Fosamax and Reclast are all anti-resorptives that work by suppressing bone turnover. Bone turnover is needed at some point for healthy quality bones.
The problem is insurance. Docs are abiding by insurance rules here. Insurance wants a bisphosphonate (Fosamax, Reclast etc.) or Prolia first. But every expert will tell you that that is counterproductive. For lower bone scores, you need a bone builder (Tymlos, Forteo or Evenity) THEN an anti-resorptive. It doesn’t work the other way around.
I would advocate with your doc for a bone builder. I am almost done with Tymlos and will “lock in” gains with Reclast. With monitoring I might be able to take a break. I had a 20% gain with Tymlos in my spine- from severe osteoporosis to borderline.
Once you are on Prolia it is hard to get off. My doc jokes that he will prescribe it when he is retiring so he does not have to deal with it. AND you cannot be on it forever. So what’s next? Another anti-resorptive? None of my docs have said we can follow Prolia with Reclast and then take a break but maybe you can. But get the timing right and demand the CTX and P1NP to monitor via blood tests.
I tried to get on meds for years. Even through cancer meds that robbed me of every bit of estrogen. I am pleased to have gotten on Tymlos by starting at a low dose and ramping up. I almost never take a full dose- usually 6 or7 “clicks” of the pen.
I have 7 fractures because COVID delayed my treatment. I know there is urgency but I encourage you to read McCormick’s book, maybe consult with him (he also wrote “The Whole Body Approach to Osteoporosis” but took meds himself. Watch Leder’s video. And try to get a bone builder if you can! Sorry to bring this all up when you are settled.
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Thanks for sharing. I already had osteopenia before I started taking aromatase inhibitors almost two years ago. I am due for another dexa scan, but I’m dragging my feet getting it scheduled. I have dealt with too many complications and I’m just not ready to reveal a new one.
@juniebug I had pretty severe osteoporosis already when I started letrozole and my docs did not prescribe Reclast because I had afib and at the time that was a risk factor. I lost about 5% bone density the first year and 2% the following 4 years.
I had spinal fractures a few months after I finished, because COVID delayed my appointment.
Just to let you know the potency for me, of Tymlos’ bone building effect: my spine is now much better than it was before cancer- 20% gain and now on the border between osteoporosis and osteopenia.
I had osteoporosis for 15 years before I finally found a med I could tolerate but I tried hard all those years and even saw an immunologist to try to get on Forteo. I am grateful for Tymlos’ adjustable dose because it allowed me to ramp up slowly.
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I can tell you are someone who does her homework! It is so helpful to hear what works for you. I might just get the dexa scan to see where I am after two years of no estrogen. I tweaked my back lifting a suitcase into my car a couple of months ago and have had difficulty standing up straight since. My breast mri shows a compression deformity near my thoracolumbar junction and I’m worried.
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I have 7 spinal fractures (at least 3 from a traumatic fall, the others osteoporotic) but can walk 20 miles in two days. Fractures hurt at first and can affect lifting, in my experience. And opening windows, opening jars…
Sounds like an x-ray and DEXA would both be helpful. It’s good to know because one fracture increases the risk of others. PT can train us how to move. Margaret Martin is an expert on this and also helpful: Physical Therapy for Prevention and Treatment of Osteoporosis (melioguide.com)
In any case it’s not a disaster to have a fracture or osteoporosis, in the end. I just hope that you are able to get medications, if needed, in the proper sequence!
And hope the pain from that “tweak” goes away soon.
Good luck with the rest of the cancer treatment. At 5 years, look up the Breast Cancer Index test to see if you benefit from extending past 5 years. I didn’t, so I stopped, with my MD’s approval.
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Thanks! Good luck to you as well!
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