I has osteoporosis and did an aromatase inhibitor for 5 years (letrozole). My docs did not want to do Reclast due to afib which was, at the time a concern with Reclast but is no longer. My bone density went down quite a bit and I fractured during COVID before I could start Tymlos.

I have done 2 years Tymlos and two sets of injections of Evenity. The Tymlos brought my bone density up and it is now better than before my cancer and aromatase inhibitor treatment.

I did a Breast Cancer Index test after 5 years of letrozole that told me that although I am high risk (our risk goes up with hormonal cancers I was told) there is no benefit to extending an aromatase inhibitor. Others do 7 or 10 years.

If you do Reclast or Zometa, your bones will probably be fine but those meds do reduce the effectiveness of the bone builders like Forteo, Tymlos and Evenity though they will still be helpful. So it depends on how bad your bones are and how fast you want to increase BMD.