Hi. This is a post I created to share some resources that were particularly helpful to me when I was navigating treatment decisions. It includes links to a couple of videos that describe medication options and medication sequencing. I found them to be incredibly helpful starting points in learning about the medication options.
https://connect.mayoclinic.org/discussion/new-osteoporosis-diagnosis-where-to-start/

Hi and welcome @front. That's quite a complicated situation you're in. I'm so glad you've managed to come here!

There are basically three classes of medications for osteoporosis.
Antiresorptives: Reclast, Fosamax, Actonel
Monoclonal antibodies: Evenity, Prolia
Anabolics: Tymlos and Forteo

Evenity is often prescribed prior to Reclast. Simply put, it builds bone as do Tymlos and Forteo. Reclast and Prolia maintain bone.

Doctors wildly vary regarding the best medication sequence. If the patient is deemed to have had a good response to medication that builds bone (as measured primarily by DEXA and TBS) , the doctor will then often prescribe a drug that is designed to maintains bone. If the patient's results are less than ideal after the bone-building medication, doctors will often continue a bone-building medication treatment and re-evaluate after a year.

In regards to Reclast vs Prolia, my personal opinion (mostly based on what I've read here) is that Reclast is a better choice. Prolia can cause fractures once stopped, and according to many doctors it must be continued for life or switched to a different medication. It's a more complicated scenario imho. Prolia also seems to have a higher potential for causing necrosis of the jaw than Reclast.
For reference, I started with Fosamax, then did one year of Evenity followed by one year of Tymlos and I had my first Reclast infusion May 2025. I had zero side effects whatsoever from Reclast. Some people do, and there's just no way to know if that will happen.
Evenity can not be taken along with Reclast. It can be done before Reclast and after, although that sequence is unusual.

As far as letting osteoporosis run its course, that's a judgment call. Much depends on the patient's overall health and their wishes. These are very powerful drugs, and may cause serious side effects that severely impair quality of life. There are many other ways to improve osteoporosis which you can explore on this site. Several people have chosen to not use medications.

I hope this helps. If you have any more questions we can answer, please don't hesitate to ask.
Best wishes to you and warm regards.