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The breakdown of bone from glucocorticoid-induced osteoporosis may be different from other low estrogen bone loss. With PMR I’m guessing you’ll be on some type of steroid over the years. By the way, one of the articles I read said that bone loss from prednisone is highest in the first 6 months, then levels off. Your bone density now might be at its lowest from the prednisone and would hopefully recover? But the likelihood that you’ll be taking some/another steroid still means you’d want to protect your bones, and it may be over the long haul - meaning finding a drug you can use over the years.
The article below says that glucocorticoid steroids cause bone reabsorption and with PMR, an anti absorption med is appropriate.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9837290/
My understanding of alendronate and Reclast is that it stops the break down of bone but might? interfere with the ability to continue to build new bone. It would be great if one of the anti-absorption meds didn’t affect the body’s ability to continue to build new bone.
For me, I’m so low estrogen that I’m just not going to build bone. I’m on Reclast, and when I stop my bones are only good until its effects wear off. But I’m still not building bone after that. But if the action causing your bone loss is a steroid, that might mean when you stop meds (steroid & anti-absorptive bone) you might start building bone on your own. That’s where it might make a difference as to which anti-absorptive med you take - is it going to lock you into be unable to build bone when there is a possibility you won’t be on a steroid. (Not sure I explained my idea well enough for anyone else to understand!!)
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I didn’t mean to imply that an anabolic bone builder be used instead. The open mic discussion from the 2024 Santa Fe Symposium, thanks to another member here, has maybe explained my point better. There are some drugs that don’t lock down the bone when stopping the med, which then allows bone building to happen when an anabolic is taken as a second step in bone health. If I were facing years and years of taking bone meds, I might want the option to use a milder drug to begin with and still have the option for a bone builder if needed later.
In the presentation discussion it was stated that Actonel (risedronate) was this type of med. Denosumab could be used right after stopping Actonel, and bone building started up right away.
For the patient that was discussed, her bone density was in the -3 level and she first started on denosumab, took a break and switched to Actonel, then went back on denosumab and continued to build bone. If your bone density doesn’t start out that low then the first drug would probably not be denosumab.
Alendronate, or zoledronic acid, might be an option for first drug you take, usually for 3-5 years. The gains are usually locked in for a few years but then density again begins dropping.
From the commentary, risedronate, might be a different option especially if the plan is to follow up with an anabolic if the expectation is that your bone density loss might speed up as you age due to very low estrogen, hysterectomy, or family history.
I am not a doctor and I’m only interpreting what I think the specialists are saying, and my own experience with bone density issues. I bring this info up as a talking point with your doctor as you figure out what is best for you.