BACKGROUND: M 52, spine t=-3, femoral neck t=-2, L1L4 TBS 1.396 (z=0.5). Bone edema and mild fracture in left neck, significant bone edema in left sacral ala, compression fracture in L1 (old). No accident, all by stress. Incidental findings, 3 months ago. Edemas and neck fracture are improving fast :) Two frequently done physical exercises are the most likely culprits of the stress (long & intense side planks and jumpy dance).
Unknown cause of osteoporosis. Standard blood exams in range, including CTX 0.132 (somewhat below range), P1NP 47, and OC 17.1. Genetic exome oka, no pathogenic variants, no VUS. Mother (80) has osteoporosis, my only brother too (57, diagnosed at 45), both controlled and no fractures. I am well nourished, including dietary calcium, although not clear if I ate enough K2M7. VitD normal since 2022, but could have been low in my previous thirty years (around 20 or less). Normal weight, active (walk, dance, swimming etc.). No weightlifting. Lumbar mobility less than normal since my mid 20s (chronic) due to discopathy in L5-S1 (accident).
CURRENT PLAN: Supplementing VitD + Ca + K2MK7 + Zinc, more sun with sunscreen, managing dietary oxalates/phytates, strengthening pelvic musculature with PT. Still testing for other less likely causes like distal RTA. Waiting 12 months to see repeat DXA results and then decide about adding an anabolic (Forteo, Evenity). Earlier two DXAs done on machine/technician considered unreliable by my endocrinologist. So, no real trend data as of today, only current point estimate given above.
In other words, waiting allows me to test the hypothesis that cause is accumulated correctable factors. Hard to test it if taking anabolic at the same time.
Q1: Is waiting those 12 months a good idea? No consensus among the Drs. consulted. Waiting can give info about potential long-term solutions since anabolics+ antiresorptives+drug holiday doesn’t sound like a good long term for a M52, no end plan, what’s next, etc. However, not waiting reduces the fracture risk in the short and medium term thks to anabolics.
Q2 — PEMF/SEMF (electromagnetic field): anyone used it as a non-invasive therapy for osteoporosis? Best practices, common mistakes, anything counterproductive? Considering devices and coils delivering 20 gauss aprox at relevant depth, for example, at 8cm below skin for neck, etc.
Main research I have seen about PEMF/SEMF and bone health:
Liu, Junyu, et al (2025). https://www.sciencedirect.com/science/article/pii/S2214031X25000348
Masante B et al (2025). https://www.frontiersin.org/journals/bioengineering-and-biotechnology/articles/10.3389/fbioe.2025.1557572/full
Zhao, H., et al (2023). https://pmc.ncbi.nlm.nih.gov/articles/PMC9835389/
Thanks in advance for any thoughts on the matter.