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    Old 10-08-2008, 10:21 PM   #1
    trail
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    Forteo and Strontium

    Does anyone know if you can take both Strontium and Forteo at the same time without problems? I forgot the important tests that should be run after you start Forteo-is it blood calcium, PTH, Vitamin D, and NTX that are the ones that you have to be careful about your levels being affected by Forteo? I remember that it's critical not to have your blood calcium too high, and that it drives your D down and the NTX up. How often do those need to be checked-my doctor tested me more often the first few months and then every 6 afterwards. He had me do a DEXA at 6 months, 12 months, and then at 24 months. Can some of you who have been on Forteo or know the answers refresh my memory? I know someone who is just starting Forteo and I want to pass the info on to her. Also, isn't the indication for Forteo that you should be postmenopausal and at least -2.5 density scores? She can't take bisphosphonates and doesn't want to take Evista, and her scores were -2.5 and -2.7 on two tests in the spine and -3.0s in hips.

    I finished Forteo a year ago and have been on Fosamax since. Just had a DEXA and my scores went back to what I was before Forteo. That combined with NTX scores that were not good makes me think that the Fosamax isn't doing anything. But, I am waiting to hear from my doctor to confirm my thoughts and discuss where to go from here. I am very unhappy to say the least and given that all the reasons that I was told brought me to osteo in the first place are all fixed(calcium malabsorption and low D) I really need some answers before moving ahead with anything at this point. I know many of you are aware of NTX numbers and what they should be, and my last 2 tests after being off Forteo and on Fosamax were 44 and 45, which my doctor said were not in the right range. It did come way down the first time after Forteo and 4 months on Fosamax from 121 to 44, but then he said it should have come down even more in the next 4 months. So, I'll see what he says.
    Trail

     
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    Old 10-09-2008, 02:56 PM   #2
    DesertBloom
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    Re: Forteo and Strontium

    Hi Trail: Geez I'm sorry that Fosamax isn't helping you more. My last NTx was 44, and the Dr said she would like to see it around 30. I'm on Evista after finishing Forteo, but my t-scores are good. I can't have a dxa as often as you, because of my insurance, so I have to rely on the NTx. Evista isn't the best drug for keeping resorption low, but I didn't want to take the bp's. When I asked my Dr about Strontium Citrate and Forteo she said absolutely not, but that's her opinion. I think her biggest complaint was that the sc you get on line or at health food stores isn't tested enough, and there's no studies on it or the Strontium Ranelate in combination with Forteo. We had a discussion about this a long time ago, if you want to read it, it should be under Forteo and Strontium. I have nothing to base this on but I would be afraid of the strontium interferring with the Forteo.

    My lowest t-score now is in the osteopenia range(spine -0.9= normal bone, femoral neck -1.6= greatly improved, total hip -1.6= no change, but my first spine score was -3.6 [on a QCT]. Actually I would like to say my score is the -0.9, but according to the doc they go with the lowest score for dx not the best.

    The tests that I had prior to Forteo were
    1. PTH
    2. D 25
    3. D 1,25
    4. total serum or ionized calcium (most Drs don't order the ionized)
    5. 24 hour urinary calcium
    6. 24 hour creatinine clearance in conjunction with the NTx
    7. phosphorous
    8. thyroid levels-if you want
    9. NTx


    If you have one of your old NTx lab print outs, it gives the reference range, but that only applies if you are taking a antiresorptive. When you're on Forteo the number should go up i.e. my last NTx on Forteo was 78 which isn't all that high but higher than normal is what you want. Now that I'm on Evista the score should drop, but I guess 44 isn't low enough since the ref range say's 30 at my lab. I'm not surprised about the NTx, and my cal and D levels are now normal (or they are for the moment) which makes it look like my hypercalcemia and low d25 and high d1,25 were driven by Forteo. We'll see what the next set of labs show, but Forteo does raise d 1,25 and calcium and lowers d25 in *some* people.

    How've you been doing? I haven't heard much from you, plus I've been limiting my time here, because the back and stomach pain makes it doubly hard to sit. If you ever registered at Medscape the article that explains this phenomenom about NTx/forteo/antiresorptives is: "Use of Biochemical Markers of Bone Turnover for Osteoporosis: Where Do We Stand? Make note of the comments on Forteo with NTx.


    Hey did you ever get the support group going up there? I can't remember if it was you but I thought it was. Was it an NOF group or a FORE one. If so hope that went well.
    Take care

    Last edited by DesertBloom; 10-09-2008 at 03:07 PM.

     
    Old 10-16-2008, 11:07 AM   #3
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    Re: Forteo and Strontium

    Hi Desert
    Thanks for your reply. I have been out of town and am still waiting to hear from my doc. He has always called me back right away and I am pretty frustrated because it has been two weeks since I got the dexa results. I looked up that article and others too on pubmed so I am prepared for when he calls. Most of what I've read says some very specific things: they give a guideline for determining failure on bisphos, like more than a 4% decline in dexa scores in at least two areas of the body and a poor NTX score. They can't determine yet that if the bisphos are failing in terms of bone loss if that also means that you are not getting any fracture protection as well. That makes it hard for me to decide whether to stay on Fosamax for that alone. The articles also say that if the failure showed at the year dexa it showed up on the dexa two years out as well, so from that standpoint there is no reason to keep taking it. The protocol is once failure is determined you should test for secondary issues, which I already have been and both my D and urine calcium are in the good range now, and my thyroid has always tested fine. Given that they say the choices are Forteo, which I have already done, and maybe Reclast, which I won't do because it is too new, and I don't like the possible side effects. Evista isn't an option for me because my mom had a stroke and I don't want to take the chance of the blood clot side effect. I know that Denosumab in around the corner, it looks like they are going to be applying for FDA approval soon and it could be sometime in 2009 that it is actually available. But, again, it is so new and I would want to see the side effect information first before considering it.


    I have started the support group on my own and we are a small group of 8 and growing. I continue to be active with FORE and have started a south bay chapter in the San Jose area where we are doing many information booths at health fairs, health clubs, and hospitals. Just spreading the word to all ages somehow makes me feel like I am helping others avoid some of the stuff that those of us who came to osteo late without information have had to endure.

    Hope your ablation goes well. I have a friend who had one last year and she is doing fabulous-no problems at all and she is off all her meds. Keep in touch.

    Trail

     
    Old 10-16-2008, 11:12 PM   #4
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    Re: Forteo and Strontium

    Trail-Sorry to hear about your one yr. dexa results. I hope your doctor can figure this out. Let us know what you learn.
    After I finished 18 mo. on forteo, I started hrt. I have now been on hrt for about 5 mo.
    It is a tough go for us once we have lost significant bone density. None of the options are pretty at this time.
    You are doing a wonderful thing to start an osteoporosis group and to be doing educational activities. Recently with a thyroid issue, a local thyroid cancer survivor group was incredibly helpful and connected me with several people who had gone to drs. I was considering and /or had somewhat similar circumstances to mine. These people were a godsend to me and helped to get me set on a better path. So, the work that you are doing could be powerfully important to others--Kudos to you trail!

     
    Old 10-17-2008, 11:22 AM   #5
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    Re: Forteo and Strontium

    Since my diagnosis is new, I wanted some feedback as to which methods of medication regimine you prefer given all the side effects that are apparently debilitating enough that you want to stop the meds. What about the yearly infusion drug?

     
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