What follows Reclast/Zometa if they are first treatment?

@izziesue two years is typical but a crazy long time to be taking a powerful and for some a dangerous drug and not know if it's working. Traditional Medicare for instance will pay for DXAs every year if your doc knows how to submit it. Not sure about other insurance. I have paid for DXAs when I wanted/needed to know where I was at earlier than the 1 year limit. At my doctors the DXAs were not that expensive ($75 for each site).
Also I test CTX frequently and use Jason Health Labs for a good price. The draw and test processing is done at a local Quest Labs in my case. I think I pay $68 for blood draw and CTX test. Much thanks to Jason Health because going direct through Quest is much more expensive.

@awfultruth I agree! Waiting 2 years between Dexas is often too long. I have asked my oncologist, my primary care doc and my endocrinology about getting my next Dexa in a year, rather than 2 years. Why? Because I will be having a Reclast infusion, take an aromatase inhibitor, and have osteopenia. All said no. My oncologist, who prescribed the Reclast, is disinclined to go to bat for me on this issue. Perhaps it takes a fracture first.

Medicare, my primary coverage, uses that 2 year rule unless medically necessary. I thought I would meet the standard of "medically necessary." My Dexa from August 2025 shows I am still in osteopenia. My oncologist and physician's assistant said they have gone to bat with Medicare over medical necessity for Dexas in a year rather than 2 year interval. They said they have been unsuccessful so no longer try.

I'd assume the patients they were trying to get coverage for have histories similar to my own. It may be that you have to establish that you have a previous DX of osteoporosis as a minimum.

Like you, I may end up paying out of pocket in a year for a Dexa. The problem is that the majority of my Dexas have all been done at a hospital and I'm sure their charges would be well above $75 here. That would mean using a free-standing facility so would lose the ability to compare scans and not have the same equipment.

Thanks for the info on Jason Health Labs. Will keep that info in mind for future use as well as the notion of self-paying for a Dexa.

@izziesue Sadly, there are docs who berate patients. Know what that feels like and it sure isn't good.

I can respect a doctor when they disagree with me or my requests for certain tests as long as they do not belittle me. Our doctors are, after all, the experts and their disdain for certain tests may be well-founded. I think those of us using osteoporosis drugs are trying to find ways to monitor our bone health and bone marker turnover tests seem to be part of that.

Unfortunately, there are few doctors or clinicians who specialize in bone health and are knowledgeable about bone markers. Finding them is like finding a needle in a haystack...maybe even more challenging than that!

If you can find one who will at least listen to you, you lucked out. The endocrinologist whom I saw for the first time was initially skeptical of ordering bone marker turnover tests as a baseline before I start Reclast, but when I made my case, she agreed and ordered the tests. She told me they are usually used after someone has been using certain drugs rather than before they start. That makes no sense to me.

I think we are educating the open-minded clinicians along the way. Perhaps they won't change what they consider to be evidence-based standard of care for monitoring bone health (the Dexa), but will pay closer attention to the use of bone markers. Neither my oncologist nor my primary care doc would order bone marker turnover tests, but this endocrinologist was willing to. I'm glad I found her.

Thank you for mentioning Jason Health Labs which I'll keep as a reference. Ideally, a doctor's order helps with insurance coverage but if that fails and we can afford it, getting these labs on our own is an option to know.

Thank you for your response! Hope you do find an endocrinologist you respect and can work with!

I

I haven't had any side effects from the Reclast infusion. My dr says after the second infusion that it is typical to take a break. I forget for how long, but you do not take Reclast indefinitley, he says.

@prarysky
For different situations as previously mentioned here, I do not have any cancers but I had a kidney transplant w Mayo Clinic AZ 7/25/23. and because a known fact of anti rejection meds cause bone loss, Mayo Clinic did bone density scans pre transplant at evaluation time, at transplant time post and at my Dec 2023 at 4 month post check up a bone density scan that showed 71% bone loss since pre transplant due to the anti rejection meds to prevent organ rejection.
My wonderful endocrinologist reviewing what I can / cannot not have w kidney transplant ordered Reclast infusion
to be 3 annuals. I have completed 2 annuals w Aug 2024 the second
and she always has me do a bone density scan week before the second annual Reclast then her visit right after. Bone density scan a yr later after 1st reclast infusion year prior showed no change holding (osteoporosis not worse and I take anti rejection meds for transplant for life.
She recommended % of foods calcium/ vit D etc w supplement dose
Reclast infusions
now done w 2nd annual
NO side affects what's so ever
but instructions before head
drink gallon water day before and after infusion gal water can be hard on kidney ( transpl kidney) I have to drink 3 L a day anyway for kidney transplant