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    Old 01-26-2008, 10:23 AM   #1
    Aleta145
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    Fosamax before Forteo

    My husband has finally decided to try Forteo, since he's been on Fosamax for nearly eight years and his spine T-score went from -3.8 to -3.6 the first year and has stayed the same since then. His first Forteo shot will be Tuesday after next.

    I remember reading something here about stopping Fosamax well before starting Forteo, but his Dr. didn't mention it. I can't find the thread, but it seems that someone was told Fosamax in the body will inhibit the Forteo at first. Should I tell him to quit now, or go on taking his next two doses?

     
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    Old 01-26-2008, 11:24 AM   #2
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    Re: Fosamax before Forteo

    Hi Aleta: I'll post a link that explains this, I can't tell you what to do, but in my case I took Actenol up to and even during the first month of Forteo, due to a mistake made by my Dr. It isn't always possible to stop a bisphos, weeks/months before Forteo, so I wouldn't worry about it. Just stop it sometime before the first shot, since a bisphos will hinder the effects of Forteo.

    Did the Dr order a bone marker test? If not, and you feel comfortable asking for it, tell him that you want to do a baseline test so you can compare to it 4 mos down the road on Forteo. I have the 2 or 24 hour urine n-telopeptide test done--acronym for it is: urine (NTx). This test will tell you how much collagen you are excreting, which is a clue to how much bone remodeling is going on. On Forteo they use this test to see how the drug is working every 4 mos, and it's best to have a baseline of this to compare to. I wasn't lucky enough to have a Dr know enough to order this test before I started Forteo, but I did have it done on my 4 month after I started it.

    In the link read the para's on "antiresorptive v anabolics", I recommend reading the whole paper so he understands this drug.

    [url]http://www.ccjm.org/pdffiles/DEAL703.PDF#search=%22forteo%20and%20ost eosarcoma%22[/url]

    Good Luck...

     
    Old 01-26-2008, 11:53 AM   #3
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    Re: Fosamax before Forteo

    Hi DB, and thanks for your reply.

    Yep, he had the blood/urine tests done on New Year's eve. Talk about waiting until the last minute before having a new deductible kick in, LOL. (Though that's a moot point now.) Yes, there was bone turnover going on.

    As for the link you posted, we have it from when you posted it before. Hubby still has it on his desktop and has referred to it several times during his decision-making. What put him over the top was the recommendation from my gynecologist last week. I'd said, "Forteo costs so much!" and he said, "A hip fracture costs a lot more." Also, the PA from his endo office (also a male) is taking it and has had wonderful results. He's the one who will be training him with the injections. He (the PA) intends to keep taking Forteo past the 24 months, BTW. I guess if he, knowledgeable as he his, is willing to take the risks, hubby is more apt to listen to him.

    He asked me to ask you about injection sites: thigh or stomach, or both? He is worried about getting the infamous Forteo spare tire. Having lost weight (from 400 lbs to 170 lbs) and kept it off for the last 25 years, he is reluctant to do anything that will affect his waistline. Also he is concerned about leg pain if he injects the thighs. What has been your experience?

     
    Old 01-26-2008, 12:31 PM   #4
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    Re: Fosamax before Forteo

    Hi Aleta: I'm glad your husband had the tests. Just remember, that with a antiresorptive (fosamax) the score should be low and with the Forteo it will go up, or that's what you want it to do. If you need verification on this I can post the article explaining this again.

    It sounds like he's got everything covered. I'm glad your gyno was able to give him the reassurance he needed. I wish I could go beyond the 24 mos, but no one will let me. If you run into any probs with the insurance just remember to ask the dr for freebies if necessary, but hopefully that won't be an issue. My Endo gets plenty of Forteo, but there's only 2 other patients taking it, so if I didn't ask for it he would throw it away.

    As far as the injection site goes, I like to do it in the thigh better. I have an easier time doing it there because of my eye sight, and not being able to bend my neck as far forward, as you need to, to inject in the stomach. I can't say that Forteo causes the spare tire. I have one but I am also loosing it some because I've changed my diet-love desserts One thing I found out, is that the med doesn't leak out if I "don't'" pinch the skin. There really isn't any reason to pinch it anyway, but I was just used to doing that from B12 injections where it is necessary, since it's an IM injection. I just let the weight of the pen push the needle in. You'll understand this more when he does it the first time. Sometimes I will inject in the stomach, because you'll find that the skin gets kind of tough, after mos of doing it, so I'll do the stomach every once in a while. I think this is just a personal preference in deciding which area to choose, or you can do both. I've never had pain from it unless I hit a nerve, which is always a possibility, but happens rarely. The needle is so small that it doesn't leave a sore spot like a large needle does. I have leg (nerve) pain, but the injection has never interfered with that.

    It'll be good for your husband to have someone to talk to about all this (PA) I didn't keep in touch with any of the people I meet at the instruction class, plus there were only 2 others.

    I hope all goes well and he has great results.

    Last edited by DesertBloom; 01-26-2008 at 12:38 PM.

     
    Old 01-26-2008, 01:36 PM   #5
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    Re: Fosamax before Forteo

    Hi Aleta: There were a couple of other questions/paragraph's I thought of so I hope you don't mind me asking them. Can you ask the PA if his insurance is paying for the Forteo beyond the 24 mos? My insurance has told me they won't pay for it beyond that period, plus I can't get any of my Drs to agree to it anyway. I'm wondering if the PA is just getting the samples from the Endo's office, that way there wouldn't be any question about insurance. However, I don't think you could ask this question, as it might cause some problems-but I'm not sure.

    The theory that bisphos' should be stopped several years before starting Forteo is an old theory when Forteo first came out. I haven't been able to find any literature that's recent that says that anymore, which is why I pointed to the Cleveland Clinics trials on this very question. In a perfect world maybe you could do it this way, but I can't think of anyone who would be willing to suggest stopping a med for that long before starting a new one. Concievably you would loose your gains during that period, so it doesn't make a lot of sense to me. I believe the CCJM's answer on this makes more sense.

    I also wanted to mention that I had the spare tirebefore I started Forteo, so I can't say Forteo caused it. I'll never forget the time I was in the hospital, 3 years before Forteo, when I was getting Herperin injections in the stomach everyday... The nurse pointed out that it was great that I had this fatty area on my stomach for them to inject into, because it would make the shot less painful. She went on to say that most patients don't have that FLAB that I have, and how lucky I was. I told her, with my tongue firmly planted in my check...thanks for pointing that out I never would have known I had that if it wasn't for you I was 13 pounds lighter then and want to get back to that weight, but the Dr says no, my bmi is normal and I don't need to do that, because it could hinder the bone growth. I still want to loose it anyway, because I hate that feeling of carrying around an extra 13 pounds. I think my problem is truly metabolism... I've always had a really fast metabolic rate, and could loose weight fast, when I was younger, but now it's a whole lot harder. I can't do any core exercises, so it makes it even worse.

    Sorry for going on so long... Tell your husband I'll be rooting for him!!! Are you waiting for the flash floods???

     
    Old 01-26-2008, 03:50 PM   #6
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    Re: Fosamax before Forteo

    Hi again,

    The PA at hubby's office is in his early 40s and his T-score was -4.x; he runs marathons and bikes marathons, so he's very athletic, so you can imagine his shock when he learned his Dx. He says a lot of people have taken Forteo for more than two years and up to five years with no adverse effects. [Yet.] I don't know if he's just using office samples or what, but we can always ask about his insurance and how he gets around the 24-month limit when we see him for the demo.

    I can see why your doctors won't let you take it beyond the 24 months. They would be SO liable if anything happened to you while taking an extended course of the drug. With DH's PA, he absolutely knows the risks and is willing to take them. I'm not sure I wouldn't do the same thing in his place. Osteo runs in his family and he is still such a young man.

    That's funny, what that nurse said about you being lucky you had the extra fat around your waist. At least it's good for something, right? You can always tell people you maintain your spare tire for medicinal purposes!

    Oh, and as for the floods, we've been hearing dire predictions of flooding for the past month or so and the rain never pans out to be as heavy as predicted. It is getting rather dark and cloudy here now though. We live on the side of a hill so hopefully we won't be slip-sliding away any time soon!

    Last edited by Aleta145; 01-26-2008 at 03:54 PM. Reason: Added something.

     
    Old 01-26-2008, 04:43 PM   #7
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    Re: Fosamax before Forteo

    I forgot to mention that my husband's first month on Forteo will be free. The PA said we'll see how well he tolerates it. He already has a lot of musculoskeletal pain from degenerated disc disease, and he's unable to take nsaids of any kind...they make his stomach bleed. So we're hoping that he doesn't experience any additional pain on the Forteo. Funny how he had ZERO problems after seven years on Fosamax, yet he can't take an aspirin!

     
    Old 01-26-2008, 05:46 PM   #8
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    Re: Fosamax before Forteo

    Hi Aleta: I'm glad you mentioned the DDD, because yesterday when I saw my Dr at LLU, she asked me again if the Forteo was helping my pain at all, which she does everytime I see her. I told her no I didn't think it was, and she said that quite a few people get pain relief from Forteo, and so much so they are doing a new trial on Forteo for chronic pain. I've talked to quite a few people that said Forteo helped their pain, but I haven't noticed that. It's mostly seen with DDD, stenosis, and nerve pain from the spine. I did notice a dramatic decrease in nerve pain, but I was attributing that to the Cymbalta I'm taking for nerve pain. I asked the Dr if I could continue to take Forteo for this pain trial and of course she said no. I was sort of joking, but it would be nice to see if continued use would eleviate some of my pain. It's possible that the great decrease in sciatic is from the Forteo and not the Cymbalta, but I'll never be able to figure that out unless I stop the Cymbalta. But something has decreased that horrible radiating pain in both legs since I started it.

    I suppose there are some here that had some kind of pain after starting Forteo, but I just don't understand how that would happen. Have you ever had pain from a hormone? I would think if your husband could handle the Fosamax with no gi probs (the main side effect) hopefully Forteo will be a breeze since it doesn't go through your stomach. My first mo on Forteo was free too, Eli Lily is supposed to give you the first months pen free at the class they hold, but I've heard some say they didn't get it free.

    I hope he doesn't have any problems, and is like me with NO side effects...

    They're still talking about the flash floods here, but you're right they never pan out. Yesterday I had to battle the rain and snow getting to LLU. The Dr was quite surprised I made it down there because she said the pass I take was closed the night before. My husband used to get stuck in that when commuting to LA and they make you sit in your car until the plows clear the road, just like in Gorman.

    Last edited by DesertBloom; 01-26-2008 at 06:00 PM.

     
    Old 01-26-2008, 06:10 PM   #9
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    Re: Fosamax before Forteo

    That would be so awesome if the Forteo actually helps him with the pain! I haven't seen that listed as a side benefit. In answer to your question about having pain from a hormone...Maybe the pain some people have on Forteo are actually growing pains caused by enlargement of the bones? I don't know.

    I just went back and re-read the Forteo abstract, and realized that it was written in July 2003. I'd sure like to see some fresh information about those patients who have been using it since then.

    I don't envy your trek to LLU if you have to go through snow. Being a coastal southern California gal, driving in snow isn't something I'd know how to deal with. I do love driving to the mountains for a little birdwatching in the summertime though!

     
    Old 01-26-2008, 06:48 PM   #10
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    Re: Fosamax before Forteo

    Hi Aleta: I just finished reading an excerpt from John Hopkins about another Forteo v Fosamax for back pain. You can probably find it by going to their website. The jist of the study was half the group were given Fosamax plus injectable water, and the other group got Forteo and a placebo pill, and the Forteo group saw a significant decrease in back pain v the Fosamax group. They go on to say that the reason for Forteo reducing back pain are unknown and that the 2 drugs work in completely different ways. Now this isn't the trial my Drs talking about, since what she mention was not a comparison to Fosamax and it hasn't taken place yet.

    I've talked to someone (nurse) who has had 12 vertebral fx's and she's in her early 30's and taking forteo now. When she started to fx she was in her 20's. Since she's been on the Forteo her back pain has diminshed considerably. They also say the same thing about calcitonin, relieving pain, but I don't think it was to the degree there mentioning with Forteo. With Forteo this is a new phenomenum about the pain relief which wasn't discussed during the clinical trials, and somewhat similar to giving Forteo post surgically to speed healing of fx's.

    If you read the Eli Lily paper on Forteo there are a lot of new additions to it, like you mentioned, and it was revised in April of 2007, have you read that one? I know that anyone taking this has their Dr report their progress and side effects back to someone-I guess it would be Eli Lily. Well at least my Dr has to do that, maybe they all don't.

    It just goes to show you that it doesn't matter how healthy, active or young you are you can still get this disorder (ref to PA).

    [url]http://pi.lilly.com/us/forteo-pi.pdf[/url]

    I was born and raised in Ca so I know what you mean...

     
    Old 01-26-2008, 07:50 PM   #11
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    Re: Fosamax before Forteo

    Hi Aleta: Here's a Forteo paper from 2005 or 2006, it's 12 pages long and you may have read it already, but it's really interesting. Your husband should find it interesting as well. You probably won't need it, but I use a medical dictionary/encyclopedia when reading some of this stuff. If you don't have one Merck has a good one free online.

    [url]http://www.jbmronline.org/doi/pdf/10.1359/JBMR.051023[/url]

    Have Fun...

    Last edited by DesertBloom; 01-26-2008 at 08:10 PM.

     
    Old 01-27-2008, 03:22 PM   #12
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    Re: Fosamax before Forteo

    Quote:
    Originally Posted by DesertBloom View Post
    ...that quite a few people get pain relief from Forteo, and so much so they are doing a new trial on Forteo for chronic pain. I've talked to quite a few people that said Forteo helped their pain, but I haven't noticed that. It's mostly seen with DDD, stenosis, and nerve pain from the spine....
    I told this to my husband and he wonders how that can be true, considering that Forteo makes bones bigger. Wouldn't bigger bones put more pressure on the disks? Any thoughts on that?

    Thanks also for the BMR paper. Here's an excerpt from that paper:

    Quote:
    The Fracture Prevention Trial studied 1637 postmenopausal women with a prevalent fracture who were not receiving hormone replacement therapy (HRT) or other antiresorptive treatments. These patients were randomly assigned to self-administer teriparatide 20 mcg, teriparatide 40 mcg, or placebo injection. This study was terminated after a median time of treatment of 19 months because of the unexpected finding of osteosarcomas in a 2-year rat carcinogenesis study.
    What I don't understand is this: Why did the FDA then approve Forteo four years later? What changed their minds?

     
    Old 01-27-2008, 06:25 PM   #13
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    Re: Fosamax before Forteo

    Hi Aleta: I’ll try to answer your questions the best I can. In the Forteo v Fosamax Trial for Back Pain Study, they reported a significant reduction in back pain in the Forteo group and no reduction of pain in the Fosamax group. The researches further explain that the reason for pain reduction in the Forteo group is “unknown.” Even though these results were seen they could not explain the action that the drug might have to reduce back pain. So the answer is no one knows how that would happen. If you want to read more about this do a query on Forteo for back pain and see if you find anything interesting. But for me it hasn’t helped with the pain, so I can’t explain how it would anyway and it seems no one else can either.

    I thought that Forteo makes your bone more dense not necessarily larger. When I went to the training class for the pen instructions they explained Forteo’s actions with the following analogy. I hope I can remember exactly how they explained this, so keep in mind that this is what I remember. They compared Forteo working on bone to a road crew that was fixing pot holes on a street and then laying down cement after the holes were filled. The crew fills the pot holes with cement (Forteo) and then a cement truck lays down a new top coat over that to reinforce the newly repaired holes. I’m sure someone else could explain this better, but that’s how I remembered it. So if Forteo fills the holes in your bone, that would make your bone stronger and more dense, then the additional layer of bone that is placed over that reinforces the repair. So I don’t think the bone actually gets bigger, but it does become more dense and of course stronger-but I'm not exactly sure.

    The FDA, and an expert panel, approved Forteo with a black box warning saying that the rat study was unlikely to predict bone tumors in humans taking Forteo, and included this info in the package insert. The risk of osteosarcoma would be very small due to the following reasons.

    1. In the rat studies the dose was 3-60 times the human dose given over 75% of their lifetime, so contracting cancer was dose and length dependant.

    2. Fisher rats are more susceptible to osteosarcoma, and contract it at a 1-3 in 1,000 rates, where human’s incidences of osteosarcoma are 4.5 in 1 million.

    3. Humans would only be able to take the drug for a period of 24 months unlike the rats who received it for most of their lives.

    4. In the second study done on Fisher rats that were treated with the human dose of 20 mcgs for 6 to 20 months, none of the rats contracted cancer.

    5. The rats in the first study were younger, than those used in the second, so their bones were still growing, which is a contraindication in the use of Forteo. Forteo can only be used in subjects where their bone is no longer maturing.

    You can find this info in the CCJM pdf on Forteo. Pg 591

    I don’t know exactly why they stopped the that trial, except that it’s not unusual to stop a clinical trial when an adverse event is found in animal trials of the drug. There were a number of other trials going on at the same time of this finding that weren’t stopped, but there was a time limit on each trial for drug administration.

    HTH

     
    Old 01-28-2008, 08:11 PM   #14
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    Re: Fosamax before Forteo

    Thank you so much for your response. You seem to have a good handle on what happens. I love the pothole analogy!

    I sort of understand about the rat studies but wonder why the researchers went to such extremes at all. It seems strange (to me) to give cancer-prone rats such huge dosages, and then be so surprised when they develop tumors that they stop the human studies. That's what I don't get.

    Quote:
    Originally Posted by DesertBloom View Post
    I thought that Forteo makes your bone more dense not necessarily larger.
    It's on page 6 of the Cleveland Clinic PDF. Here's an edited-down quote from it:
    Quote:
    Anabolic drugs build bigger bone, not just denser
    ...Anabolic drugs, in contrast, increase osteoblast and osteoclast function...increase turnover and remodeling, and increase the remodeling space. Therefore, anabolic drugs may prevent fractures not only by increasing bone mass: they may also change the geometry of bone...Treatment with these drugs enlarges bone by increasing periosteal and endosteal apposition of bone, creating a mechanically stronger bone by increasing its size.
    He goes on to say the DXA may not be the best way to evaluate BMD gains from Forteo because it measures area and not volume. It compares DXA with CT scans (which measure volume) and the CTs registered much higher BMD gains on the Forteo than the DXA. I thought that was interesting, and wonder whether your gains are actually much more than you think.

     
    Old 01-28-2008, 10:59 PM   #15
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    Re: Fosamax before Forteo

    If there's such a small chance of patients getting bone cancer then why is Forteo only limited to two years? I just get so frustrated when I think about needing treatment maybe indefinitely and then a time limited medication is all that is available (PTH type). The study facts about Forteo didn't seem to indicate that a longer length of time might cause it but hihger/stronger doses did.

     
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