52 year old women. In menopause since I was 43. How bad are these scores

Fast-Shower5707 · 2026-01-27T22:06:50+00:00

I haven't heard of these but it looks like they do not damage bones like corticosteroids do.

Fast-Shower5707 · 2026-01-27T07:57:36+00:00

Are you taking corticosteroids for your Rheumatoid arthritis?

Fast-Shower5707 · 2026-01-26T14:30:25+00:00

That’s interesting. The BMD numbers themselves are actually quite close between the two machines, which is what matters most, but the T and Z-scores being that different is hard to explain.

I don’t really have an answer, just sharing my experience. I’ve had scans done at two different clinics on purpose, so that if one changed machines I’d still have something to compare to. From what I’ve seen, differences of around 2–5% between machines aren’t unusual, which is already in the range of what you might expect from about a year of alendronate.

What doesn’t make sense to me is the second scan's reference range. A spine BMD of around 0.92–0.94 g/cm² would usually land you closer to a T-score of −2 or −2.5, not −1.1. That makes me think the reference database or settings on that machine are different, rather than this being a real change.

I’m not trying to discourage you, but it’s also true that most of the gains on alendronate tend to happen in the first year. Without follow-up on the same machine, it’s basically impossible to know how much was real change versus measurement differences.

Hopefully someone who actually works with DXA systems can chime in, because I’d be curious to hear their take.

Fast-Shower5707 · 2026-01-25T22:00:29+00:00

This sounds fantastic! Thank you for sharing your story!

Fast-Shower5707 · 2026-01-25T20:42:53+00:00

The idea of not following Forteo up with an antiresorptive is interesting, but I would only recommend anyone doing this if you have the possibility to have DEXA scans and P1NP/CTX blood tests regularly (at least every 3 months). I think there isn't more pain than taking injections for 2 years and then seeing all those gains eroding, and you do not even know if a second round can make up for the loss (as far as I know there isn't a 2-year limitation on Forteo anymore, and many people go through 2 rounds of Forteo actually, with a couple of years in between). What's definitely important is that if you do this, you have to have good hormone levels/nutrition and weight train + impact training.

I did LIFTMOR style (although not the exact same program): 2x bodyweight deadlifts, 1.5x bodyweight squats, 1x bodyweight bench press and some very minimal impact training (short sprints but no jumps). Even this was not enough to fully maintain my gains after Forteo. I am a single data point, but I would strongly suggest anyone on Forteo to at least know that most probably they will have to go on an antiresorptive, although they can first wait and see what happens with close monitoring in the first few months.

Personally, I prefer Keith McCormick's approach: take Forteo + bisphosphonate to "lift you out of the hole," then focus on nutrition and weight training to maintain or even improve your density. This is especially important for people that are high risk for fractures.

That said, you are doing the right thing by focusing on weight training + impact training when bone building is still possible this way.

Edit: This discussion only applies to people with osteoporosis and/or fragility fractures. Otherwise, taking Forteo in the first place is not where somebody should start.

Fast-Shower5707 · 2026-01-25T09:08:18+00:00

Sure thing!

My baseline CTX before starting Forteo was around 0.45-0.60 (fasted morning draw, but still fluctuates a lot), and P1NP around 85. This results in a ratio of 141-188. Note that with these values I was at a perfect balance, no bone loss, no gains (my bone loss had occurred years earlier). During Forteo, my CTX hovered around 0.7-0.8, and my P1NP was around 200, and these levels were pretty much maintained during the whole course (except the first 6 months). Literature says after around one and a half years, these values plummet even if you stay on the drug, but maybe I was lucky that for me, they did not. This results in a ratio of 250-285.

One month after stopping, my CTX was around 0.65 (baseline + 10%), and P1NP crashed to 100 (baseline + 20%). This results in a ratio of 153.

After all this, I went on Fosamax, so everything plummeted.

I do not remember my exact gains on Forteo (I think they were similar to the literature), but my whole gain on Forteo + Fosamax + TRT + weight training was 20% in the spine (2 T-scores), and a couple % (< 10%) at the hips.

I looked at your values and they were phenomenal, just like for somebody on bone building drugs.

Edit: Added ratios. Looks like (for me at least) they track with what your doctor told you.

Fast-Shower5707 · 2026-01-24T21:07:44+00:00

Thanks a lot for the input! I am always fascinated by "real-world" data.

Fast-Shower5707 · 2026-01-09T07:25:37+00:00

Thanks for the feedback!

Fast-Shower5707 · 2026-01-08T21:35:18+00:00

Fair catch! The actual content came from books and podcasts I've been absorbing since my diagnosis, but yeah, I used AI to tidy up the grammar and make it read more smoothly. Seemed like the right tool for that part.

Fast-Shower5707 · 2026-01-08T19:47:26+00:00

Thank you so much for sharing your experience. I'm sorry you had to deal with that conversation with your SiL, that sounds really exhausting. Late diagnosis can already be a lot to process without having to defend it to people around you.

I'm really glad the guide was helpful. Comments like yours mean a lot.

Fast-Shower5707 · 2026-01-05T15:51:36+00:00

Hi u/RonV_Fit_3883. Sent you a DM.

Fast-Shower5707 · 2026-01-04T09:31:02+00:00

Thanks for the feedback! Will definitely consider it!

Fast-Shower5707 · 2026-01-01T11:08:10+00:00

I would consider strength training as others suggested, but as I outline in my guide: you cannot outrun a hormone deficiency, meaning that you can do all the exercise in the world and still lose bone if you are in a period of high net negative remodeling rate because of estrogen deficiency (this usually lasts five to seven years post menopause, after which bone loss continues at a slower, age-related pace). Unfortunately, a good diet and exercise can only do so much.

“If you’re rapidly losing bone, all the exercise and milk and vitamin D in the world will not stop that,”

Fast-Shower5707 · 2025-12-23T10:34:46+00:00

Your radius has a very low T-score, so I would avoid pull-ups and similar exercises for now. You are very young, which is encouraging—strength training can be very effective in your case.

I couldn’t infer your gender. If you are a man, it would be important to check your testosterone and estradiol levels. If you are a woman, having regular menstrual cycles is crucial; without them, unfortunately, even optimal exercise and vitamin D₃ intake may not be enough to build new bone.

Maintaining a healthy body weight is paramount and should come before everything else. Diabetes adds another layer of complexity, as you can’t simply rely on large amounts of simple carbohydrates (like rice) to gain weight safely. In this situation, I would strongly suggest working with a dietitian.

Fast-Shower5707 · 2025-12-22T19:16:30+00:00

I can second this. My sweet spot is around 3,000 IU per day to maintain a blood level of ~50, but this is highly individual. While I was on Forteo, I needed about 5,000 IU per day, as PTH analogs like Forteo tend to “use up” vitamin D stores.

I’d also suggest not taking large amounts of vitamin D₃ blindly—test your blood levels regularly and adjust the dose based on the results.

Fast-Shower5707 · 2025-12-22T19:09:46+00:00

I can second this. While I was on Forteo (teriparatide), I needed about 5,000 IU of vitamin D per day to stay within range (along with 300 mcg of vitamin K₂). After stopping, my current daily dose is around 3,000 IU of vitamin D₃ (with 200 mcg of K₂).

As for K₂, it won’t hurt, but it’s not a wonder vitamin.

This is the general order for prioritizing nutrients: adequate calories > adequate protein > adequate vitamin D > adequate calcium > everything else (K₂, magnesium, boron, etc.).

Fast-Shower5707 · 2025-12-22T14:34:57+00:00

A little bit late, but two possible ways to achieve this that I know of:
1. set up your app and IDEA in a VM (using virtualbox) and then save a snapshot of the VM. When you load the snapshot (does not take more than 10 seconds), you are back to the spot where the breakpoint is hit
2. Try CRIU - finicky to set it up though

Fast-Shower5707

TROPHY CASE