After bisphosphonates then what

@gently thanks for this- always learning!

"The reductive effect of prior bisphosphonate use (and vitamin D use) are said to equalize to normal response within a year (observed, not proven)."

I am also concerned about the blockage of the SOST pathway and functions of sclerostin throughout the body, including CNS. After Tymlos I have done 4 months and am stopping. That was sort of a compromise plan: to get the burst of bone growth at the beginning of Evenity with minimal time suppressing sclerostin. I hope they are doing more research on suppression of sclerostin in the body.

windyshores, it's a little off topic but a reminder of how complex things are. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10477312/

There is new study that I no longer have access to that had the same results in mice, but the mice brains were injected with sclerostin. So you have to wonder if the injecting causes some disturbance.
(Will we all be taking Evenity to slow alzheimer's? someday)

My doctor, who specializes in osteo as well as RA and lupus, just put me on a "drug-free holiday" for a year (after 4-5 years of being on a bisphosphonate). Now, I am back on the bisphosphonate, likely for another 4-5 years. Mayo Clinic comments on why this is okay:
https://www.mayoclinic.org/diseases-conditions/osteoporosis/in-depth/osteoporosis-treatment/art-20046869#:~:text=So%20your%20doctor%20might%20suggest,medicine%20remains%20in%20your%20bone.
I assume my doctor doesn't want to ratchet up the treatment as my progress is "good enough" with the weekly pill.

Serious, you've been on medication that preserve older bone and prevent both remodling and acquisition of new bone. And it has (likely) been effective at preventing fracture. Both reclast and prolia share that mode (by different mechanism) of prevention of bone loss. They are antiresorptive. And I think not adviseable.
Consider Forteo or Tymlos, no matter the bone markers. Redue the markers at 1 month and 2 months. Comparison to baseline is less important than the markers at 1 and 2.
The reductive effect of prior bisphonate use (and vitamin D use) are said to equalize to normal response within a year (observed, not proven).
Unless you have medical reasons prohibiting estrodial replacement, you might consider a patch or bioidentical not instead of but in addition to an anabolic.
I'm finishing a year of Forteo without negative effect and consider it the best on the market.
I will avoid Evenity because of known adverse effect and because of the unknown effect of blockage of the SOST pathway both in the brain and in the cardiovascular system.
Cheers to your endocrinologist. We are all looking for someone with those qualities.
Best luck in your choice of medication.

This conversation has confused me. I am being seen by an endocrinologist at The Mayo Clinic in Rochester. My Dexa for my spine was osteopenia but my trabecular score was osteoporotic and wasn’t good. My CTX blood marker showed high reabsorption. He suggested I shouldn’t wait to start treatment and prescribed Reclast, calcium carbonate and vitamins D. I have had one infusion. From this conversation, if I have understood it correctly, Reclast isn’t preferred because it inhibits new bone building. Is this correct? Also I read the study about the mice (https://pubmed.ncbi.nlm.nih.gov/25314004/ ) and it suggests taking a calcium-collagen chelate dietary supplement. Have any of you found this product and are taking it?

hi, awfultruth.
When trying to determine why some on anabolic treatment had lower response numbers by dxa, two associative factors were found. Individuals who hadn't taken bisphosphonates and individuals who hadn't taken vitamin d, had the best response numbers. Associative factors are determined by self-reportage and by the simple numbering ( meaning oh, these ten didn't have a good response and they are the same ten who report taking vitamin D daily in the prior years). These associative reports aren't as reliable (or interesting as) mechanism of action factors.
Later tracking indicated that those low response bisphosphonated, D'd patients had equal response in less than but close to 2 years of anabolic treatment.
Mechanism of action were later determined for bishphosphonate use. The drug clads the bone for many years preventing the remodeling effect of osteoblasts as well as osteoclasts.
Mechanism of action for D seems to be (someone probably knows for sure) the greater absorption of calcium from the intestine. The parathyroid meds tested work by pulsed flooding of the serum with calcium followed by reduced calcium in the serum, though it is subsequent effect that increases BMD.
Even if this is completely clear (let me know), it may not be completely right. Even the research is slightly speculative as we discover when further research reverses these concept. The part I trust most are the mechanism of action, but even those can be are overturned because of misinterpretation.
Bless our researchers!