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Dear ALL, I've just sent an email to Prof. James Whitfield, distinguished retired Prof. of the Canadian CRC in Ottawa -- Prof. Whitfield is one of the world's leading experts on osteoporosis: As you recommended in 2013, I switched from Forteo to Prolia; this showed an improvement in my last Dexa (a little under two years ago); however, according to the former head of Orthopedics here at UR, this improvement is illusory. After switching to Prolia, I noticed that my nails became much weaker: Posts in the Calorie Restriction Society Website suggest that this is normal for those practicing Calorie Restriction. However, I recall that nail strength correlates with bone density -- so to me this suggests the likelihood of worsened osteoporosis. Happily, my endocrinologist (Professor Steven Wittlin, Head of Endocrinology at UR Medicine) has put me back on Forteo (at my request). I've been on daily injections of Forteo for a little under two weeks -- almost immediately, my nails grew hard -- I haven't seen them like this for more years than I can remember. Also: My nails are growing faster. Previously, I didn't need to cut them more than once a month -- now, probably about every 2.5 weeks. This (almost immediate) change in nails -- harder nails, faster growing nails -- if it translates to bones -- suggests improved changes in bone density, and in growth of new bones -- in other words, Forteo having it's usual osteogenic effects. As usual, I'd very much appreciate your thoughts on that. Concerning my daughters: The oldest, Ashira, is halfway through the MD/PhD program at NYU; she is married, with a 5 month old son -- my first grandson! The youngest, Meira, finished her Bachelor's Degree at UNC Chapel Hill, major Economics, and is currently working for KPMG (a large international tax firm); she has a boyfriend who I fully approve of. Both daughters, my son-in-law and grandson came to stay with us for the first two days of Passover last weekend. (Both daughters live in Lower Manhattan.) -- Saul On 02/16/2013 02:27 PM, James Whitfield wrote: Hi Saul: It seems that for a period Forteo works but then the response slows down. This is known to happen. It might be wise to put pauses into the Forteo treatment. During a pause the bone would regain its osteogenic responsiveness to Forteo as you have in fact seen. During the pause you could try the RANKL blocker. In other words try a pulsed treatment. How are the girls? <Jim> -----Original Message----- From: Saul Lubkin [mailto:email@example.com] Sent: February-16-13 12:44 PM To: James F. Whitfield Cc: Steven Wittlin Subject: Possibility and wisdom of taking Forteo and with Prolia Dear Prof. Whitfield, It's a pleasure to contact you again! I hope that life has been good to you, and that your new research interest in Alzheimer's disease has been progressing well. My personal reason for writing you concerns, as usual, osteoporosis, about which you of course continue to be one of the world's leading experts. Let me describe my current situation: I've been on Forteo for quite a while, and it's been improving my bone density at multiple sites. As I noted, in 2008, my Endocrinologist, Dr. Wittlin, noted little if any improvement on my dexa. So I was switched to a biphosphonate. After 6 months on the biphosphonate, my bone density plummeted. So, I went back to Forteo, and bone density began building up again, at a good pace. And I've been on Forteo up to and including the present. However, I've had a Dexa last Monday -- and it showed little change in the spine, a small loss of bonethe femoral necks (-6.4%) and a small gain in the trochanters (+1.9%). Dr. Wittlin thought it might be best to switch me to Prolia. My understanding is that Prolia binds to RANKL, which is expressed by osteoblasts, preventing RANKL from binding to RANK, expressed by pre-osteoclasts, and thus preventing the pre-osteoclasts from developing into osteoclasts, thus reducing the normal bone resorption accomplished by osteoclasts, and therefore helping -- not really to build new bone, but reduce the rate at which bone is resorbed. In this effect, it resembles the effect of biphosphonates; both also reduce the remodelling rate. Because of my bad experience with biphosphonates, I am very reluctant to try a drug that resembles the effect of biphosphonates -- although admittedly by a very different pathway. Continuing with Forteo, I think, is likely to at least maintain what gains I currently have achieved, and prevent rapid loss of bone density. The possibility has occurred to me of taking BOTH Forteo and Prolia. I recall that previous studies have shown that, taking both Forteo and biphosphonates is essentially equivalent to taking biphosphonates alone -- the effects of Forteo overwhelm those of the biphosphonates. This suggests to me (correctly or not?) that Forteo combined with Prolia would not slow the remodelling rate -- my guess is, that the enhanced remodelling induced by Forteo would persist. It's possible that the Prolia might be effective in reducing the rate of maturation of pre-osteoclasts, as it usually does; and that the combination might thus be effective in growing bone, in my type of osteoporotic: A slow remodeller. Your thoughts on this would be much appreciated -- and if you think that the combination might be worth a try, I'd like to try it, if possible. At any rate, it's a pleasure to contact you again; and let me again congratulate you on your being awarded the much justified title of "Emeritus Researcher for Life". -- Saul