Undecided choice of drugs for Osteoporosis

Thanks. I would need a study to show my doc!

I am sure the Physicians Desk Reference did not make this up.

Of course but I am just saying I need the study it is based on. My doc would not accept this. I have been hoping to influence his practice which is unrealistic I guess.

What are you going to take after two years on Forteo? I am afraid of Reclast but I have read that Fosomax, which I tolerated very well twenty years ago, does not work as well.

janflute, the scariest effects of Reclast affect only (yikes) about 22%. There is a way to reduce the percentage to about 1% according to the well-known bone expert who conducted the reclast clinical trials.
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"I have prescribed a lot of Reclast (zoledronic acid), which to my knowledge is always administered in an infusion center, and not in a physician's office. My strong recommendation based on my knowledge of bisphosphonates (given that I helped to develop three of them, and treated 13,000 patients in phase 3 trials with them) is to have the infusion center dilute the 5 mg of zoledronic that comes in 100 mL of D5W into 500 mL of NS, and infuse the endodoc recnow 600 mL over 60 minutes. Making the drug more dilute and administering it more slowly significantly improves the renal safety for N-containing bisphosphonates.I also strongly recommend that the infusion nurses give the patient 650 mg of acetaminophen (Tylenol) at the time of the infusion, and that the patient take that same dose with dinner and at bedtime the day of the infusion, with all 3 meals and at bedtime the day after the infusion, and a final (7th) dose of acetaminophen with breakfast the 2nd morning after the infusion. These 8 doses total of Tylenol reduce the chance of a symptomatic APR (Acute Phase Reaction) from 22% to < 1%.Best, endodoc." (Karpf)
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Reclast (zoledronate) adheres more strongly to the bone and persists in the bone for a longer period of time than Fosamax (alendronate). Risidronate has the least adherence and for the shortest duration. If my tentative plan fails, I will take risidronate to lessen the reductive impact of bisphonates on the second application of Forteo.
Osteoclasts and osteoblasts work best when coupled. Forteo, Tymlos too, establish a period of time when stripping the bone of fissures combines with laying down new bone in perfect balance--the bone anabolic window. An advantage of the balance is that osteoblasts are said to changed into osteocytes in the bone itself and they are the cells responsible for remodling.
My plan for myself is to follow the bone markers to maintain and then reestablish the anabolic window without sacrificing too many osteoclasts and without the bisphosphonates that prevent osteoblasts from penetrating the bone or from seating new bone.
It appears from my markers that after seven months I should have stopped Forteo. As it was at eight I stopped for one month and had the robust rise in osteoblasts and drop in osteoclasts with resumption. The markers may dictate the use of a bisphosphonate. I would then choose Actonel) risidtonate as it is the least "effective."

Tymlos gave me excellent gains. But my femur neck was still -3.6. Both my endos (two different practices) have never done Evenity after Tymlos but agreed to let me try it. One doc said this is my very own protocol. Not suggesting it for anyone else- I don't know the results yet!

@gently are you saying that Forteo's bone-building action was renewed by taking a break?

Great post by the way.

@nwyatt I think you can take Forteo after Evenity but I was told that since Evenity "turbocharges" bone density, there isn't much left for Forteo to do. I would bet that there is not yet enough research on this.

My doc wanted me to do Reclast after Tymlos and save Evenity for later. But using Fosamax or Reclast makes later bone builders about 1/3 less effective, according to Dr. Leder's video on YouTube on Combinations and Sequencing.

So even though there is no data on Evenity after Forteo or Tymlos either, I am essentially a guinea pig for my doc's practice. Just one guinea pig but the first!

janflute, the scariest effects of Reclast affect only (yikes) about 22%. There is a way to reduce the percentage to about 1% according to the well-known bone expert who conducted the reclast clinical trials.
_________________________________________________________________________________________________________________
"I have prescribed a lot of Reclast (zoledronic acid), which to my knowledge is always administered in an infusion center, and not in a physician's office. My strong recommendation based on my knowledge of bisphosphonates (given that I helped to develop three of them, and treated 13,000 patients in phase 3 trials with them) is to have the infusion center dilute the 5 mg of zoledronic that comes in 100 mL of D5W into 500 mL of NS, and infuse the endodoc recnow 600 mL over 60 minutes. Making the drug more dilute and administering it more slowly significantly improves the renal safety for N-containing bisphosphonates.I also strongly recommend that the infusion nurses give the patient 650 mg of acetaminophen (Tylenol) at the time of the infusion, and that the patient take that same dose with dinner and at bedtime the day of the infusion, with all 3 meals and at bedtime the day after the infusion, and a final (7th) dose of acetaminophen with breakfast the 2nd morning after the infusion. These 8 doses total of Tylenol reduce the chance of a symptomatic APR (Acute Phase Reaction) from 22% to < 1%.Best, endodoc." (Karpf)
________________________________________________________________________________________________________________________________________________________________

Reclast (zoledronate) adheres more strongly to the bone and persists in the bone for a longer period of time than Fosamax (alendronate). Risidronate has the least adherence and for the shortest duration. If my tentative plan fails, I will take risidronate to lessen the reductive impact of bisphonates on the second application of Forteo.
Osteoclasts and osteoblasts work best when coupled. Forteo, Tymlos too, establish a period of time when stripping the bone of fissures combines with laying down new bone in perfect balance--the bone anabolic window. An advantage of the balance is that osteoblasts are said to changed into osteocytes in the bone itself and they are the cells responsible for remodling.
My plan for myself is to follow the bone markers to maintain and then reestablish the anabolic window without sacrificing too many osteoclasts and without the bisphosphonates that prevent osteoblasts from penetrating the bone or from seating new bone.
It appears from my markers that after seven months I should have stopped Forteo. As it was at eight I stopped for one month and had the robust rise in osteoblasts and drop in osteoclasts with resumption. The markers may dictate the use of a bisphosphonate. I would then choose Actonel) risidtonate as it is the least "effective."