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Reclast vs Fosamax??
I am being given a choice of either Fosamax or Reclast starting in January, when I will have ended my two years on Tymlos. Does anyone have some evidence-based opinions/advice/medical input whether to opt for one or the other? I know that Reclast is "stronger," since it is infused. But I wonder if that is a good thing or a bad thing in terms of "locking in the gains" of the anabolic. In these Mayo Connect posts, I've read of really ill effects from Reclast, which makes me nervous (looks like one person who posted ended up in the ER; others seem to have had long-term effects). But the idea of taking one shot, then forgetting about all of this for a year is so attractive. With Fosamax, I'd have to take a pill every week, which really isn't that bad, but I would so like to be done with this osteoporosis stuff. Never had a fracture; otherwise in good health; no other meds; age 74.
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Below is a link to an Osteo Boston interview with Dr. Lewiecki.
At about the 49:00 mark a woman asked him about following Forteo with Reclast or Fosamax.
Maybe this would apply to Tymlos as well.
I am not sure if my story will be helpful since I was on Evenity.
But your concerns paralleled mine.
My first Mayo Rochester endocrinologist’s (he left) plan was Evenity and then followed with Reclast (5mg) once a year for 3 years. I finished up with Evenity in August 2025 and in September I had another Dexa Scan and a follow-up appointment with my new Mayo doctor.
When I discussed my next medication with this doctor, I expressed my concern about having the full dose of Reclast. I wasn’t concerned about the APR (Acute Phase Reaction) because I have read all the posted protocols to do prior, during and after the infusion. I was, however, concerned about long term effects that I have read patients reporting. I told her that I thought the joint ache I was having was possibly from the Evenity and didn’t want to chance more long-term discomfort/pain.
I asked her if I could have a lower dose of Reclast and she said no.
However, she also gave me the option of going on Fosamax (Alendronate). I am not sure if the fact that I had significant gains from the Evenity had anything to do with offering me this other choice. I decided to go on Fosamax. If I have problems with Fosamax, I will ask again about the lower doses of Reclast.
From reading posts on Mayo Connect and Inspire I know that other patient’s doctors were agreeable to lower doses. I also consult with Dr. Keith McCormick. He said that finding a doctor that will give lower dose Reclast is difficult. I asked him if he thought Reclast was better than Fosamax and he said it would give me a little more density. Dr. Lewiecki in his interview said that the efficacy of Fosmax and Reclast was about the same.
Dr. Benjamin Leder’s interview was helpful to me as well.
Not sure if he had a question about Tymlos sequencing.
He said near the end of the interview that he does give low dose Reclast to some patients.
I hope some of this is of help.
Thank you to all who post on this forum it helped me with my decision.
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1 Reaction@sebutler I don't know if it will be -1.5, but it was -2.0 in January after nine months on Tymlos, so I expect (hope) it's even better by January.
I've also been doing a lot of exercise over the past two years, and my back is definitely much stronger, so all that is helping.
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1 Reaction@sebutler I’m so happy to hear you fared well on Tymlos. That’s wonderful.
And you just gave me some new info I should look into because I took alendronate for four years in a row, and that is a biophosphonate. Hmm…
Thank you for that. I hope your Monday has been kind to you. 🌻
I am also 74, only had a wrist fracture about 10 yrs ago. I have been taking Fosamax for about 6 months now and have had no side effects at all. I have not taken other bone meds to compare it with, but I am so far happy with it. I just hope its doing its job!
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1 Reaction@njx58 You are doing all the right things!! Congratulations!
I had one Reclast infusion last November and decided this year to go with Fosamax. Like so many have already said, I feel more in control by taking the pill. Yes it is a nuisance to take every week but I am praying my density test next July shows remarkable improvement. I feel the Reclast caused me to have belly fat. Otherwise no problems. Just concerned.
@ladybugnc Thanks for sharing your experience!!
I had my first Reclast infusion 10 days ago. The next day I developed a high fever, high pulse rate, high heart rate, rigors (uncontrolled full body shivering). I went to Mayo ER and was diagnosed with SIRS (Systemic Inflammatory Reaction Syndrome). I was admitted to the hospital and got out about 24 hours later.
SIRS is an immune system overreaction - a cytokine storm - and can be dangerous. The ER has to treat as if you have an infection (which I did the previous two times), so I got IV antibiotics as empiric treatment (as in "we don't know what's causing this, but we'd better do what often works"). I had a remarkable collection of screening tests for all sorts of pathogens (all negative).
I believe this reaction is really rare. I was expecting the not uncommon "few days of flu-like symptoms" so didn't go to the ER as soon as I should have.
Today, I'm still recovering - just tired.
But if you have a history of SIRS or sepsis (they are very closely related), this is a possible risk. But again, I think my case is rare - due to my tendency towards SIRS.
@sebutler 🙏🏻🙏🏻🙏🏻
@rotate Thank you for sharing this. Yes, undoubtedly rare, but still gives me pause. Glad you have recovered -- what an experience to go through!