You can take anabolics afterward but effectiveness is reduced by about 1/3 (see Dr. Ben Leder's video on YouTube on Combinations and Sequencing). But still very helpful.

As I wrote before, I could not take Reclast during cancer treatment and had fractures, but I started out with pretty severe osteoporosis. You could use blood marker tests for bone turnover and growth as well as DEXA to keep track of what is happening with your bones. Two blood tests that might be useful are the CTX and P1NP (do them fasting and early). Do you have an endocrinologist?

Tymlos restored my bones to better than before cancer. So if you don't do a bisphosponate, there is that and Forteo and Evenity if you get into trouble. I don't know how bad your osteopenia is but a doctor could assess whether you can afford to do an AI without Reclast or Zometa.

ps I am 9 years out and have not yet done a bisphosphonate. I am going to start soon to lock in gains from Tymlos.

Very good question! I'm 58 yrs, thin build and within only one year of Letrozole for ILC am now in osteoporosis. My endocrinologist said should start with bisphosphates and after labs he cleared me for Fosamax. I 'm very anxious but trust my endocrinologist at MGH in Boston. Reclast infusions were a bit too harsh for me to accept with even more potential negative side effects but now it seems like many on this site start with Zometa hoping to avoid bone mets but I did read that all bisphosphates might help with this concern. Thoughts? xoxox