Hi @prehorselover - If you have a good response to Evenity and you have not had any adverse events, I would go with option 1. Take alendronate for two years and get rechecked. If you want to go further, go on Evenity again, but I would take a one year break (no drugs) before hitting Evenity again. This will allow Fosamax to wear off a bit making Evenity a more effective. The nice thing about option one is that you are limiting your exposure to just two drugs.

I like Fosamax better than Reclast because the effects do not last as long when you stop. The theory is that your bones will be able to repair areas more effectively during your drug holiday (no drugs) and the osteoanabolics will work a bit better after the break.

If you do take Fosamax, I highly recommend you wait 2 hours and not just 30 minutes before eating (or drinking anything but water). This is how the trials were run and it allows up to 40% better absorption (you can read this in the package insert). Another tip - drink only RO or distilled water for that two hours. Calcium in water will deactivate Fosamax to some extent. Mineral water and Mountain Spring water have the highest calcium content so stay away from those for that 2 hour period. They are great choices any other time.

If you don't have good results, option 2 might be the best choice.

Also, when you get your DXA scan, ask if they can include a TBS score. That will be helpful for your decision.

I wish you the best of luck!

Mike