I was on alendronate 70mg once a week for nearly four years with no side effects. My spine remained the same at -3.9, which is fairly severe, and my hip worsened slightly from osteopenia to -2.7. I am now taking the bone-builder Forteo (it hasn't even been a month yet). In my opinion the decision whether to start on a bone builder vs BPH should take the severity of your osteoporosis into account as well as any previous fractures (I'd had two wrist breaks, one from standing height) but I was put on a BPH with no discussion of any other treatment possibilities, and I didn't know enough at the time to ask. It's true one needs to go on to a BPH (or Prolia, which itself would have to be followed by a BPH if you want to come off of it) to hold your gains from the bone builder, after which one could potentially take a drug holiday. I'm a proponent of treat to target--once my bones get to a place where my fracture risk is considerably lessened, I want to stop the drugs. To me even mild osteoporosis is acceptable, though of course I'd like to get into osteopenia if not normal. It will mean continued monitoring to see what kind of shapes my bones are in and possibly drugs again at some point.