Choosing Our Poison

I don't see how you can touch the osteoclasts without affecting immunity.
https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2019.01408/full
Co-effects really need a separate term from side effects or adverse events. I suspect that when we have a noticeable "side effect" it is just the surface warning of a more damaging "co-effect. " Verbal distinctions with physical connection

Again, I am not talking about side effects but reactions that are fundamental to the way a drug works. Some people can afford a decrease in immunity; those who are immunocompromised cannot. If sclerstin suppression would also suppress healthy bone marrow activity, I am not willing to have my cancer go from stage 0 to even stage 1.

I find that kind of comment to be fear-mongering. It is NOT knowable that not taking a bone med will result in fracture and long-lasting pain. Some (many?) osteoporotic people don't take them and never fracture. Some people fracture when they only have osteopenia. Some people taking the drugs fracture anyway, sometimes multiple times. I am not anti-med, I'm currently taking alendronate and considering my next drug. But I would challenge any doctor who made such a comment to me.

@cat1203 I have to express some support for the comment by @juanitalinda and her doctor. The risk of fracture is much higher without meds. What you are describing is kind of a Russian Roulette approach. Some of us have lost!

I am not pro-med necessarily for osteopenia or even early osteoporosis but as someone with 7 spinal fractures I am on this forum to encourage others to try meds and avoid what I have been through- pain, disability and even (temporary so far) loss of independence.

Osteoporosis has no symptoms and we feel strong. But the risk is there and if bone density and/or quality declines enough, we can fracture while coughing.

I think what I described were accurate and true statements about potential outcomes regardless of whether one is on meds or not. Of course the risk of fracture is there. Whether the risk of fracture is much higher without meds I think is a blanket statement that does not take into account an individual's particular risk level. I am not advocating a Russian Roulette approach to taking meds or trying to discourage anyone from taking them, or from taking their doctor's advice. Nor am I trying to encourage anyone to take them because of my own personal outlook or experience. It's their decision. Nevertheless, I stand by my opinion that no doctor can say definitively that they KNOW you will fracture if you are not on a med.

My comment was made about my conversation with my doctor. And I realize that unfortunately, my situation is very serious and not typical. (I certainly hope I am an outlier!).

But I think that it was pretty safe to safe that he KNOWS I will fracture without medical intervention.
I broke my femur in 5 pieces while bending over to pet my shepherd (not a small dog). Three months later I broke my rib while sleeping. Three months later I fractured a vertebra, standing still when I coughed.

As far as I can tell, the only way to stop a fracture is to get my 70 year old bones stronger as soon as possible.

@juanitalinda my last reply was in response to windyshore's comments on this conversation, actually. In light of the context and history you subsequently shared, I'm not disputing your doctor's certainty that another fracture is a given without meds. But they may happen anyway even with them. And no one can dispute that. I most certainly hope you don't fracture and wish you the very best on your course of meds. I"m sorry if I offended you . I'm bowing out now.

the conclusion from the study linked by @gently basically says that it was once thought the immune system affected osteoclast, but this study demonstrated a reciprocal effect. That said, both Prolia and Evenity affect the immune system, These meds all work a little differently of course.

"Conclusion
In the last decade, remarkable advances have been made in understanding the interactions between the skeletal and the immune system under both physiological and pathological conditions. In particular, the influence of T cells on OCL formation and activation through complex cytokine interactions including TNFα and RANKL were thoroughly investigated and immune cells were shown to regulate bone cell differentiation and activity. Today however, these interactions are known to be reciprocal, increasing further, the interest for OCLs as immune cells.

Depending on the context, different OCLs are described to derive from distinct progenitor cells. Based on the numerous OCL precursors described, and on the recent identification of an iterative fusion of mature OCLs with circulating monocytic cells2 (38), the possibility of OCL heterogeneity is huge. Additionally, some precursor cells seem to differentiate much more easily than others depending on their context. The existence of heterogeneous OCL populations appears unsurprising when considering that OCL precursors, including MNs and DCs, have been described as phenotypically and functionally heterogeneous for many years. Thus, bone destruction does not rely only on an increase in OCL differentiation and function, but also on the recruitment of OCL subsets that differ from steady state OCLs.

These novel insights in the field of osteoimmunology open new exciting perspectives and emphasize that OCL function is not restricted to bone resorption but expanded to immune cell differentiation and immunomodulation. Based on these observations and according to their immune function, OCLs could act as key players and regulators of the bone immune status in steady state as well as during inflammatory processes and they should not anymore be regarded only as bone-resorbing cells. Therefore, relying only on bone resorption may not be sufficient to block inflammatory bone destruction. New specific anti-resorptive agents targeting inflammatory OCLs and the associated T cell interaction could provide a very novel effective strategy to control inflammatory bone loss and the bone environment without compromising physiological bone remodeling by steady state OCLs."

My comment was made about my conversation with my doctor. And I realize that unfortunately, my situation is very serious and not typical. (I certainly hope I am an outlier!).

But I think that it was pretty safe to safe that he KNOWS I will fracture without medical intervention.
I broke my femur in 5 pieces while bending over to pet my shepherd (not a small dog). Three months later I broke my rib while sleeping. Three months later I fractured a vertebra, standing still when I coughed.

As far as I can tell, the only way to stop a fracture is to get my 70 year old bones stronger as soon as possible.

My sincere apology for the misunderstanding. I took your comment in a global sense and not as it referred to your situation. Unfortunately, there are all too many people who play on our fears. Instead of a rational analysis of that is right for each of us, they resort to fear mongering.