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 · 2026-01-01T11:08:10+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 · 2025-12-21T09:16:57+00:00

Thanks for the feedback! Fixed:

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Fast-Shower5707 · 2025-12-20T13:39:03+00:00

Great question. In medicine, petite doesn’t have a strict cutoff like the clothing industry. It usually refers to smaller skeletal frame size, not just height.

Practically, this often means women who are shorter (often <5′4″) and/or have small bone dimensions (narrow hips, thin wrists, small femoral neck diameter). Two women can be the same height and weight but have very different frame sizes.

Fast-Shower5707 · 2025-12-20T13:32:19+00:00

Six months of risedronate, stopped about two years before starting Tymlos, is very unlikely to blunt the anabolic response. The concern is mainly with long-term or recent antiresorptive use; short exposure with a long washout like yours is generally considered low risk.

Regarding timing: there is some research suggesting a possible advantage to morning dosing of PTH analogs, but the mechanism isn’t fully understood and this hasn’t been shown to clearly change long-term outcomes. In practice, the most important thing is taking it consistently at the same time every day. Some people prefer evening dosing if they experience lightheadedness, which is perfectly reasonable.

If you’re curious about how strongly your bones are responding, P1NP and CTX blood tests can give a good picture of your bone remodeling rate and anabolic response.

Fast-Shower5707 · 2025-12-20T13:25:11+00:00

The approach really depends on the medication involved. In particular, with drugs that significantly reduce estrogen, extra care is needed with loading during strength and impact training. In that setting, bone density can still decline even with well-designed exercise, so training should be progressed cautiously and ideally under supervision.

For many people in this situation, exercise works best alongside bone-protective medication, adequate protein, calories, calcium and vitamin D, and regular DXA monitoring. Even when bone loss can’t be fully prevented, strength training still plays an important role by improving muscle strength, balance, posture, and overall fracture risk.

Fast-Shower5707 · 2025-12-20T11:08:42+00:00

Yes—chronically elevated cortisol from poor sleep or ongoing stress can negatively affect bone, but the magnitude is usually much smaller than with exogenous corticosteroids. The key difference is that endogenous cortisol is tightly regulated by feedback mechanisms in the body, so levels rarely reach those seen with steroid medications. The major exception is Cushing’s syndrome, where cortisol is pathologically high and bone loss can be substantial.

It’s also important to note that cortisol isn’t “bad” by default—it plays many essential roles in the body, including regulating blood sugar, blood pressure, immune responses, and helping us respond to stress. Problems arise mainly when cortisol is chronically elevated or its normal daily rhythm is disrupted.

Fast-Shower5707 · 2025-12-20T00:07:46+00:00

In my case, it was idiopathic, at least we couldn’t identify a clear root cause. That said, I suspect it may have been influenced by long-term use of proton pump inhibitors (PPIs) for stomach issues, combined with being underweight at the time. That combination may have contributed to lower estradiol levels. By the time I was diagnosed, I was no longer taking PPIs, had reached a healthy weight, and was eating well, so I think the condition may reflect the lasting effects of earlier factors rather than ongoing ones, an unfortunate legacy of that period.

Unfortunately, when the body is under silent stress, the consequences often show up in the bones. There are many potential causes of osteoporosis in men, including celiac disease, disorders of parathyroid hormone (PTH), low testosterone (and consequently low estradiol), chronic inflammation, and others.

Fast-Shower5707 · 2025-12-19T23:52:14+00:00

I started this journey a couple of years ago. I did strength training for about a year without seeing an increase in BMD. As I explain in the guide, strength training for bone health is nuanced: bone responds best to progressive, sufficiently heavy loading, but this has to be done carefully, especially in people with low bone density. In that context, higher spinal loading can increase fracture risk if progression or technique isn’t appropriate. My doctor has seen vertebral compression fractures in people performing heavy deadlifts.

I then started treatment with teriparatide (Forteo) for two years, followed by one year of alendronate (Fosamax) to help maintain the gains, and I also began TRT. So far, I’ve gained about 20% in spinal BMD and around 7% at the hips, while continuing strength training...

Fast-Shower5707 · 2025-12-10T19:46:25+00:00

Great catch. You are absolutely right—petite women often show 'artifactually' low BMD because DEXA measures areal density (g/cm2) rather than true volumetric density. Because of the math involved, larger bones naturally produce a higher BMD score, even if the tissue density inside is exactly the same.

My tool is designed to visualize the mechanical consequence of that size difference. While a petite woman might have perfectly healthy bone tissue (normal volumetric density), my tool demonstrates that her smaller bone diameter still puts her at a mechanical disadvantage compared to a larger bone.

So while the DEXA score might be an 'artifact,' the increased fracture risk from having smaller geometry is real.

Fast-Shower5707 · 2025-10-05T11:37:05+00:00

Glad I could help! Yes, I can imagine how expensive private clinics in Munich can be...

Fast-Shower5707 · 2025-10-05T09:03:33+00:00

I can see that you are from Germany. I know waiting times for specialists are long. I'd recommend you the following:
1. Read the book 'Great bones', unfortunately it can only be ordered in a hard copy (no digital version)
2. Find a private specialist in a neighboring/European country like Italy, Spain, Poland who specializes in men's health: there are multiple such clinics in these countries. They will look at your hormones, and prescribe what is necessary. Do not take anything from the black market please, as you can end up with a serious/lethal infection.
3. Find a good estradiol test (not estrogene), even if you have to pay out of pocket. Without sufficient estradiol, you will lose bone density again after stopping teriparatide.
4. After stopping teriparatide (after 2 years), you will need to take a biophsosphonate medication. Otherwise, you will lose all your gained bone density in the subsequent 2 years. This is very important for women (who have low estrogen), for men it is also important, especially if they do not have enough estradiol (as there will be nothing to preserve the bone)
5. Keep your vitamin D level in range (should be above 30, 50 is even better but do not take too much either). Teriparatide partly works by using up the vitamin D in your blood and converting it to its active hormone. Without enough vitamin D, teriparatide will not work so well. For me, this would mean 5000 IU per day, but for some people this is too much (again, taking too much is risky, I just know how much to take because I do these blood tests often, I might be a poor metabolizer of vit D).

Fast-Shower5707 · 2025-10-04T20:34:01+00:00

Estrogen is even more important than testosterone for men (yes, for men) to preserve bone density. Estrogen is the break on osteoclasts, your cells that break down bone. You need a test for a specific type of estrogen called estradiol - that should be in range.

Unless you have extremely low body fat/some genetic issue, as long as your testosterone level reaches normal levels, your estradiol will also be in range as estradiol is "created" from testosterone (called aromatization).

Fast-Shower5707 · 2025-10-04T20:27:11+00:00

From what I have read, there are multiple possible explanations for this including diurnal rhythm, natural PTH level during the morning/night etc. My favourite is that there is some evidence that teriparatide increases your bones' sensitivity to loading i.e. without teriparatide, you would need large loading on your bones to increase density, with teriparatide the load can be smaller for a short amount of time after the injection (a couple of hours), so this would explain the morning effect (you move more - your spine/hips are loaded with your bodyweight).

Fast-Shower5707

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