@normahorn since I am doing a reduced dose I plan on asking about this. I am supposed to be doing an infusion 4 times/year to get what is considered the normal dose per year, but I am delaying my 3rd since my CTX is still low.

Your question is extremely important since none of us have been given a long term plan and we may have quite a few years left.

For example, for me personally, with Tymlos (2 years), Evenity (1 year- though I only did 4 months), Reclast (3-5 years) the total is 6-8 years so what happens after that? Not Prolia, since that would require Reclast again and I don't want to take it anyway. Forteo is now okay for more than 2 years for a limited number of us but effetiveness may wane after 1 year.

At what point does Reclast succeed in "locking in gains"? The rest of the time is to build bone densiity. If gains from previous meds are achieved by Reclast in one year, I would want to go back to do Tymlos, or maybe alternate Evenity for 4 months with Reclast. These are things I am going to discuss with my doctor and will report back. I know there are ongoing studies....

Maybe doing less Reclast less often will extend the duration of treatment as you say.

This is all speculative and based on my own situation and not advice! We all have individual situations to discuss with our doctors.

Yes, frustrating not to have more answers but I found this (eventually!) helpful: Kept asking the endocrinologist I came to after my osteoporosis finding (no broken bones or other known issues) "but what about after... " questions (this after a year of Evenity and just now Reclast). It took me a few times until his response finally registered: that the research on osteoporosis treatments is developing so rapidly that we can't know what things will look like in the coming years / can't predict now what will be best to do in different situations. (And I'd add that things I would think can only improve....)

@normahorn my endo just wrote me that my CTX of 145 shows that Reclast is suppressing my bone turnover. He forgot that I had only 1 mg in June and 1mg in September and none since so I reminded him and asked if I could delay any further infusions until monitoring shows it is needed. I mentioned that his colleague has said that it is possible only 2 mg/year might be effective. (I remember McCormick said any CTX< 100 is over suppression).

We'll see what my doc says. He normally doesn't do CTX. I fear being a PIA but I have to take care of myself. I try to be humorous with him.

I said I was "eager" to talk and want to ask about more Tymlos/Forteo, or maybe 4 months Evenity then some Reclast then another 4 months Evenity then Reclast. Or whatever his research is showing.