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."