In 2022 my father (62 years old at the time) had a compression fracture in his lumbar spine while putting in a dock section at his cabin. Since that time, he has had ongoing back pain. They have performed cortisone injections and radiofrequency ablations as methods of controlling his pain but nothing had proven to be too effective in pain control. I have recommended that he start some sort of consistent/progressive exercise program which he has yet to do. He does walk frequently, occasional elliptical, and is generally active with daily chores and such but less so now that he is retired.
He underwent a bone scan and was diagnosed with osteoporosis. (I’ll edit this when he sends me his T-Scores). It was recently suggested that he try Forteo injections daily for 1 year. This would run him about $12,000 dollars total for the year out of pocket. This is obviously a fair amount of money.
I’m curious if the BBM crew has any opinions on this medication in terms of bone health vs other less invasive (i.e. not injection based) or less expensive medications? I will also work with him to understand that his pain is probably only partially caused by his bone health and he needs to start working on exercise to improve his load tolerances to his spine.
Appreciate the feedback - Thanks
Does he have any other underlying medical conditions?
Has he seen an endocrinologist to ensure a complete evaluation for osteoporosis in men? This includes testosterone, parathyroid function, calcium/phosphate/vitamin D, kidney/liver function, urinary calcium excretion, and potentially other tests for less common causes.
Agree that he should be training.
Treatment should be focused on any underlying cause that is identified in the above testing – for example, testosterone replacement if the individual is found to be significantly hypogonadal. If no treatable cause is clearly identified, there are several other treatment options, including the far less expensive (and potentially oral) bisphosphonate family of drugs. Forteo is not typically used first-line in this situation, but is an option along with others such as Prolia.
Thanks Austin - He said they did a bunch of blood tests and as he recalls the only thing that came back as positive was high level of urinary Calcium excretion. He has a hx of at least 1 relatively recent kidney stone (last 5 years) and one in the distant past which may be associated per some resources I looked at? He is going to send me his lab values once he finds them. He didn’t know if his Calcium levels were low off the top of his head.
Here are Bone scan results for what its worth:
| Region |
TScore |
Zscore |
| Fem Neck |
-2.5 |
-1.7 |
| Lumbar |
-3.3 |
-3.1 |
| Forearm |
-2.1 |
-1.5 |
Yep, these numbers just confirm the presence of osteoporosis. I would not assume that the evaluation was complete unless I saw exactly what was done. There are also other treatments that can reduce urinary calcium excretion, even though they would not be enough to reverse this on their own.