@flowergal I hope you are seeing an endocrinologist.

I did letrozole for 5 years with preexisting osteoporosis which got much worse and I fractured my spine a few times- pain and disability result.

My endo did not want to do Reclast during my cancer treatment because at the time they thought it worsened afib. I did Tymlos after treatment and my bones improved dramatically.

Most people on aromatase inhibitors like letrozole do Reclast or Zometa (both zoledronic acid). These drugs are thought to possibly have some protective effects in terms of spread to bones. But they also reduce the effectiveness of bone builders like Tymlos, Forteo and Evenity.

An endo needs to talk to your cancer doctor about whether you can take Tymlos or Forteo during your letrozole treatment. As suggested to me, you would then follow it up with Evenity then Reclast or directly to Reclast.

I did 2 years Tymlos, 4 months Evenity and now Reclast and am doing well.

We don't know what your bone density is. If osteoporosis is mild you could just do the usual Reclast with your letrozole. Most people I know do Reclast with their letrozole.