I was on Fosamax as my first medication. I was diagnosed with osteopenia in 2014 and did not take any medication for four years. I was on HRT plus calcium supplements. In 2018 my DEXA showed osteoporosis. My OB-GYN recommended a consult with a rheumatologist but my insurance provider would not approve the referral (I didn't try very hard) so my PCP prescribed Fosamax.

I dutifully took it for over five years. My lumbar T-scores improved a lot during the first two years. Hips improved a bit but not as much. I was told that I may be able to take a "drug holiday" after five years.

Just after my fifth anniversary of taking the med, I suffered a compression fracture at T8. I didn't think it was possible and the fracture wasn't diagnosed for three months as I never went to the doctor (chalked it up to a back muscle strain). My T-scores had worsened after the third year on it but neither my OB-GYN or PCP thought to do anything about it.

I am now on an anabolic drug, Evenity.

My recommendation would be to see an endocrinologist specializing in bone diseases like osteoporosis before starting on Fosamax. There are so many factors that go into treating this disease. Lifestyle is a big part of the treatment. I think Fosamax is OK but I would make sure your doctor keeps an eye on your T-scores while you are on it and I would not stay on it for more than a couple of years.

If you already have severe osteoporosis (T-scores of -2.5 or lower) then it would be better to start with an anabolic like Tymlos, Forteo, or Evenity. This is because taking Fosamax can make those drugs less effective if you fracture and have to take them later. This is the situation I am in. I have no idea how well the Evenity I am will work because of the years of Fosamax. Fosamax binds to your bones and is released back into your bloodstream and starts suppressing bone metabolism all over again. This is why it can be so effective over a long period of time.

But Fosamax also eventually suppresses bone growth because bone growth is triggered by bone breakdown, which Fosamax stops completely. This is why a drug holiday is recommended. Some people end up with even more brittle bones because their bone gets old on Fosamax and never gets replaced. This is what happens when someone experiences an atypical femur fracture - their femurs are so old, dried out and brittle because the bone hasn't been replaced for years that they just snap.