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oldestof3 Asked May 2015

I can't see giving my Mom a shot a day. Who can I find to do that?

The doctor wants to start my Mom (93) on Forteo for a fracture @ L3.

pamstegma May 2015
Forteo is actually very similar to PTH (parathyroid hormone). So if mom is hypothyroid, I would want to know if there are other answers, for example is she deficient in magnesium which would affect PTH. Is she lacking Iodine or phosphorus? Would Kelp help? Fosamax? Carbonated drinks have phosphoric acid, so why not wash the calcium down with a Coke? Just because something is expensive, doesn't mean it works better.

Veronica91 May 2015
Oldestof3 I had never heard of Forteo. My research tells me it was approved by the FDA for use in humans in 2002 having been studied in rats and a small human trial of less than 2000 high risk patients for less than 2 years. Some of the rats developed cancer in their bones but apparently rats bones grow for their entire lives and the cancers were in the growth area. No human developed cancer so it is advised not to use it for longer than 2 years. Quite a lot of regrowth of bone was noticed in the trial participants but once the drug was stopped it could only be maintained by adding Fosamax which itself is not without problems. The injection itself is given subcutaniously into the belly or thigh and in itself is not a big deal. The needle would be similar to those used by diabetics.
there are several things to consider,
1 Mom is 93
2 She has little pain and can move around.
3 she would probably be distressed by a daily injection and likely become anxious and think there was something REALLY WRONG with her.
4 It is unbelievably expensive From memory $700 a month
The main things to keep in mind are encouraging a healthy diet containing plenty of calcium and keep her moving but be very careful to protect her from falls.
Was the fracture discovered by chance or did she fall and have an x-ray that revealed it. Many elders especially with osteoporosis do have what are called compression fractures of the spine which just happen. You need to guard her as best you can so that she does not have any other fractures. You did not mention Mom's general health both mental and physical but at 93 her life expectancy can not be too long so your idea of keeping her safe and comfortable is the way to go.

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surprise May 2015
I know nothing about osteoporosis, but I understand where you are coming from. If she has no other medical issues and could easily live another 10 years, the shots might make that more comfortable for her. However, if she has severe dementia, those shots are going to become battlegrounds on a daily basis, and you really do have to ask how is this helping? You might want to find someone who specializes in geriatric medicine as her PCP. If she has something serious like Alz or cancer, you might want to find a palliative care practice which will help you balance the costs and benefits of each therapy.

GardenArtist May 2015
Apparently a little computer gremlin altered your original post!

I see your point now and understand your concern.

Some questions to clarify the need vs. desirability:

What kind of doctor recommended the shot? An orthopedic doctor? Or was it a primary care or internist?

Were any DEXA studies done of your mother's bones so that you have histories of how much change there has been over a period of time?

Personally, I would agree that your mother's comfort and mental level are equally important. I also personally have strong feelings about some of the osteoporosis meds, specifically Fosamax.

I would (a) ask the doctor how long he/she anticipates these shots would be necessary/desirable; and (b) research Forteo, especially its side effects.

Fosamax which was recommended for my father had side effects and has been the subject of class action suits. Although strongly encouraged by his PCP, my father refused to take it after the first go-around in which he found it a difficult drug, and I supported him because of the strong side effects beyond the digestive issues.

It wouldn't hurt to get a second opinion - perhaps make an appointment with an orthopaedic specialist and inquire about PT, if your mother isn't already getting it. From all I've read, weight bearing exercise is the best method (assuming the personal can tolerate the exercise) for osteoporosis prevention.

I should also reveal that I have a strong objection to drugs that are "desirable" but not "necessary" - but that's just my personal opinion.

oldestof3 May 2015
I did not ask in my original question who can I find to give Mom a shot. I don't know where that came from...does the website 'fix' the questions we ask for more answers. My thinking is do I really need to put Mom thru a shot a day at 93? She has a little pain from L3 but is still able to be up and around. My goal is to make her feel safe and keep her comfortable. I think giving her a shot a day would only add to her anxiety.

GardenArtist May 2015
Ask one of the hospital/rehab nurses or even a doctor's nurse to show you how to give the injection. Those that can be administered by nonmedical personnel can be given in areas that don't require the skill of knowing medical procedure. Lovemax is such a drug; I'm not familiar with Forteo but it sounds like it might be a similar drug that can be given by a lay person.

Having written that, I chickened out when my father needed Lovemax after he glared and glared and glared at me and I decided it would be better to have one of his friends who was a nurse give the injection. He wouldn't glare at her. All that glaring shook me up and I might have ended up injecting myself.

Reading some of the negative statistics on fractures might be more convincing.

I assume she's not in rehab, as if she were, the nurses there could administer the drug. Or is it the drug itself to which you object?

pamstegma May 2015
Consider that not giving her the shot will lead to further deterioration in the spine and much pain. Shots are much less invasive than a surgical procedure. If the treatment can offer hope to delay paralysis, I would give it a try.

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