Reclast after Forteo?

@jmanj, I bookmarked your post in September. It is so unusual to take only one Reclast injection. I'd like to skip Reclast and would love an update on your treatment. May I ask who your endocrinologist is.

Dr. mannstadt at Brigham. Thank you so very, very much for this wonderful information. I love taking Forteo and I hate to have my two years come to an end. I feel that it builds quality bone, not brittle like Fosamax or Reclast. My dentist does not want me to take Reclast. I have way to many crowns, and have ready had to have two teeth pulled and have implants. Your information to me is priceless.❤️

I do not know if Dr. Mannstadt checks bone turnover markers. I see him on May.15. By a gentler antiresorptive, could that be Fosamax? I took Fosamax from 2003-2008 and had no side effects, but I do not think know if it helped very much..

@janflute All bisphosphonates have similar physiochemical properties, but their antiresorptive activities differ substantially. For example Reclast is stronger than fosamax, and fosamax is stronger than boniva or actonel. Then there are differences in the “stickiness” to bones among the bisphosphonates. Fosamax can stay in bone for up to 10 years. The length of the “stickiness” also depends on the rate of bone turnover. By comparison, the terminal life of risedronate/actonel is only 20 days.

Ask your endo to choose a sensible bisphosphonate for you, depending on your goals and strategy going forward, short and long term. I think the “gentleness” as well as the terminal life of each bisphosphonate will make a big difference, if you are going to have a second round of FORTEO.

Dr. mannstadt at Brigham. Thank you so very, very much for this wonderful information. I love taking Forteo and I hate to have my two years come to an end. I feel that it builds quality bone, not brittle like Fosamax or Reclast. My dentist does not want me to take Reclast. I have way to many crowns, and have ready had to have two teeth pulled and have implants. Your information to me is priceless.❤️

Thank you. From reading your response, it seems that my dentist does not know as much about Fosamax vs Reclast as he seems. He told me that he wanted me to take Fosamax because when/if I need to have another tooth pulled there would be less problems with my jaw because I could stop taking Fosamax, but Reclast would be staying in my system. What do you think?

@janflute All bisphosphonates have similar physiochemical properties, but their antiresorptive activities differ substantially. For example Reclast is stronger than fosamax, and fosamax is stronger than boniva or actonel. Then there are differences in the “stickiness” to bones among the bisphosphonates. Fosamax can stay in bone for up to 10 years. The length of the “stickiness” also depends on the rate of bone turnover. By comparison, the terminal life of risedronate/actonel is only 20 days.

Ask your endo to choose a sensible bisphosphonate for you, depending on your goals and strategy going forward, short and long term. I think the “gentleness” as well as the terminal life of each bisphosphonate will make a big difference, if you are going to have a second round of FORTEO.

@janflute i dont know for sure. What I know is, if someone is treatment naive, ie, never had fosamax before, the chance of onj is very small during first few years of treatment from clinical data. You had ~5 year fosamax a long time ago, more than 10 years, presumably all the fosamax that was bound to your bone are gone by now. Are your bone free of fosamax now? That's a question you could ask your endo. If it is, it may not be a bad idea to use it again. But you might not want to use it for too long if another round of FORTEO is in your mind. There are observations that one year use of fosamax wouldn't interfere anabolic effect too mcuh. Then again, each person is different, what works for someone else, may not hold true for you. This deserves a good discussion between you and your endo.

@mayblin it seems, from your posts, that Reclast might be best if we are satisfied with anabolic results and just want to "lock in" gains. But if we are not satisfied with results and have exhausted the active phase of an anabolic the first time around, and anticipate another round in the future, a weaker bisphosphonate might be best. Do you agree?

My doc is prescribing Reclast but also says I may do an anabolic in the future.