I am considering multiple drugs for OP. I am 64 Diagnosed in 2019 (and right before covid!) so didn't get follow up immediately. I just ate well - and tried (always active, ran, etc.) to limit activity to daily walks and lighter gardening.

My 2025 T-cores are L1-L4 -4.8 with .59 density and right hip -2.6 with .68 density. *These have not changed since original DEXA in 2019. I do wonder if we (women) have a perimenopausal dip in hormones, loose a lot of bone, and then stabilize until we have general age associated loss...so in general most women are diagnosed later in life. I had back pain and complained enough to warrant a DEXA.

Shortly after my 2025 DEXA I had a breast cancer (BC) scare. I had two forms (ADH - atypical ductal hyperplasia and LCIS - Lobular Carcinoma In-situ) of pre-cancer in my right breast and opted for a prophylactic double mastectomy due to genetics and life time risk score. The path report on the breasts showed no additional precancers/cancers and I required no further treatment. New lifetime breast cancer risk score is 2-3%. : ) Now it is time to deal with my bones....

I am seeing a bone specialist and below is a list of what is on the table for treatment. I am concerned about long term use of anything because I am still young - and there is longevity in my family with multiple in maternal line living to 100 and paternal 80 with my father soon to turn 92! I am healthy and have no prescriptions but I do take 2000 units of Vitamin D since I was a little low on a spring 2025 reading. All is good now.

I am looking for any pearls of wisdom on these drugs and welcome comments along the lines of "I wish I knew before I started this drug that...."

I have read more recent posts in this thread from persons who have been on OP drugs for 10 years and are in 70's and 80s' - would your choice have been different if you were younger?

My bone specialist recommends going for an osteo-anabolic and then moving to an anti-resorptive - or I could chose one and not the other - or none.

Anti-resorptives
These medications slow down the bone breakdown process so that your body can naturally build bone density back up
Fosamax/ alendronate - pill once a week for 3-5 years
Actonel/ risedronate - pill once a month for 3-5 years
Reclast/ zoledronate - IV infusion once a year for 3 years
Prolia/ denosumab - injection every 6 months for life

Osteo-anabolics
These medications stimulate new bone density to form
Forteo/ teriparatide - daily injection for 2 years, followed by one of the medications above
Tymlos/ abaloparatide - daily injections for 2 years, followed by one of the medications above

FYI I did not see an Oncologist because I had "Lobular Carcinoma In-Situ".. in situ meaning it didn't spread so isn't a cancer despite its name - and since there was no evidence of more BC. My PCP thought she would refer me since there is an oncologist in the area who works closely with BC patients who have OP ...and since drugs between the two diseases can have mutual benefit. I have not seen an endocrinologist because my metabolic panel is great. I do wonder if the oncologists would more deeply understand OP drug interactions - any insight?