What are the long-term positive/negatives of taking osteoporosis meds?

I read your mind @gently 🙂

Charts from manufacturer and clinical studies show continued bmd increases over 12mo treatment period with Evenity, although the rate of increase declines gradually from beginning months towards the end of 12mo. Could this simply be explained by the strong upswing of P1NP (osteoblasts activity) during very early stages (~2wks post first dosing being strongest)? The pattern of bone marker changes with evenity resembles a pure anabolic, guess what, teriparatide when used with a higher dose once weekly formulated in Japan. This makes us wonder if a short burst of P1NP means a long lasting effects of osteoblasts then to the eventual mineralization, which shows up in dexa scan. Might these prolonged sequential events explain bmd increase throughout 12mo? The dual effects of evenity undoubtedly augment its bone building capability.

Julie 59,
a brief rundown
There are basically two classes of osteoporosis medications: antiresorptives and anabolics.
It seems like there are a lot of choices because the bisphosphonates have so many different names. Some based on whether you take them by mouth or by infusion. There are two other medications Prolia and Evenity that are also antiresorptive. The work primarily by interrupting the normal process of bone renewal by stopping the initial stage of breaking the bone down. So they increase bone density by collecting older, fissured bone.
The yearly infusion you are offered is Reclast (brand name) zoledronate (generic). It blocks the cells that break down bone effectively and collects the older bone efficiently. Generally, people are given a second infusion after a year.
Prolia is every six months. Once you start Prolia, it is difficult to quit because it it blocks and collects the cells that breakdown bone and when you stop all those acid producing cells are released on your bone and many have multiple fractures. These patients almost always take Reclast for one or two years after Prolia.
Evenity is an injection every month. It blocks the production of the cells that breakdown bone in the pre-cell stage. And adds some bone over the old. Normally followed by another medication Evenity is given twice, though now some are taking it for two years.
Then there are the anabolics: Tymlos and Forteo. They encourage the normal process of renewal of the bone. Increasing the cells that build bone and the cells that break bone down. Called remodeled bone it is the best most resilient, most integrated bone. Both medications are self given by injection with a tiny needle every day.
With all these drugs there are side effects for some individuals.
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