I'm Afraid To Stop Forteo After Two Years. Is There Rebound? Will Bones Resume Thinning?

Question

Asked by mavisdonnelly

I'm Afraid To Stop Forteo After Two Years. Is There Rebound? Will Bones Resume Thinning?

I'm a 60 year old physician dx'd with osteoporosis at just 55. my bone density WORSENED with Boniva for two years. I have a VERY strong family history of bad osteoporosis in females. I am also very thin with a BMI only 18.2; I can't gain weight. I do exercise, take 5K IU Vit D3 (still low levels, though!), and calcium. After 20 months on Forteo my osteoporosis actually reverted to minimal osteopenia. I am VERY AFRAID to stop it but my two years are up as of last month. What do you advise? Aren't there studies of what has happened to women's Dexa scans when they stopped it? I can't seem to find any and Lilly is surely playing it safe re liability concerns. I'd rather get treatable sarcoma than fractures and disability. Is there any rebound worsening after stopping it? THANK YOU! Mavis D. MD

Answer

Hi mavisdonnelly, welcome and thanks for your question. Typically, those who've finished 24 mos of Forteo start to lose the BMD gains they see with Forteo. This is the reason why an antiresorptive is strongly recommended shortly after Forteo, before a decline begins, if it does. When I took Forteo I followed with Evista and now HRT. I didn't lose my gains, like most, and am still in the osteopenic range after completing Forteo in 2009. I went from severe OP with 6 fragility spinal fraxs to osteopenia without any new fraxs, and have remained in that category. I am not a doctor; just a patient who did well on Forteo with many years of study on the topic of OP. I realize there isn't much on BMD loss after Forteo, as far as clinical trials or studies go. There are a few studies on sequential treatment with Forteo and another on Prolia post Forteo. I feel that being fracture-free is the most important part of treatment with any anabolic or antiresorptive. I had 6 spinal fraxs before Forteo and none since, so I did exceedingly well with Forteo. I would talk to your doctor and think about which of the antiresorptives would be best for you post Forteo, if that is what you choose to do. Since Boniva didn't help I'd assume that wouldn't be your choice, however, as you know, there are other antiresorptives to choose from. Forteo has a very short half-life (apprx 45 mins), so that is the main reason for follow up tx. The bisphosphonates have a half-life of apprx 5-10 years. You may want to determine why your 25 OH D is low since it is very important to have this score in the normal reference range for any of the drugs to work to their full potential. I hope you and your physician find something that you'll do well on if you choose to take a antiresorptive. There are also new drugs in the pipeline that hopefully will be FDA approved soon (Romosozumab & Odanacatib). Best of luck and I hope you remain fracture-free since that is our ultimate goal.