Since I had my Dexa 5/19 have been doing a deep dive on osteoporosis. Revisited my genetics and discovered that I am homozyogous for the risk allele on two of the key SNP’s. The effect or this is degradated WNT16 signalling cause by over-production of a glycoprotein --Sclerostin-- in the bone osteocytes. Sclerostin suppresses bone formation, and I have too much of it.
This was important because it told me that I should be on Evenity, a monoclonal antibody that suppresses sclerostin creation. So I am now waiting for approval for that. Before I re-discovered this genetic problem I was set to start teriparatide, which targets the parathyroid. My bone markers showed that parathyroid and all markers are at the low end of the normal range. For my particular osteoporosis Evenity is the correct drug. I cannot emphasize how important it has been to have done my genetics – not just for this issue, but also cardio, cancer . . . .
So, sclerostin – what else besides Evenity can drive it down? Resistance training. Impact. Possibly metformin. But Rapamycin can drive it up. Estrogen. possibly DHEA also suppress it.
The other thing I learned is that there is a correlation between higher sclerostin levels and Alzheimers. My mother has both osteoporosis and advanced AD. So, Evenity might potentially help delay neurodegeneration.
I wish I had know all this 20-30 years ago! (though Evenity is a recent medication.