Newly diagnosed with osteoporosis.

What are your DEXA scores and have you had any fractures?

Like you, my doctor recommended Fosamax (I can't take Tymlos or Forteo due to parathyroid issues). I have severe osteoporosis and decided not to take it based on articles I read that said it offers minimal fracture prevention benefits in postmenopausal women without a prior fracture or vertebral compression. It does make your DEXA numbers better because you retain old bone. The only reason I'd consider a bone drug was if it offered considerable fracture prevention, because isn't that the reason for taking a medication?

There are many articles about studies done on this, here is one: https://www.amjmed.com/article/S0002-9343(24)00101-3/fulltext
The last paragraph offers a summary of findings: "for patients with osteoporosis based on bone density alone, treatment benefits are less certain. Hip fracture risk reduction is modest and not supported in patients without a history of fracture. Reductions in vertebral fractures are substantial regardless of baseline risk, but whether these reductions correspond to less chronic pain and disability is unclear. Clinical evidence is weaker for newer agents. Future guidelines and reviews on osteoporosis treatment should clearly distinguish between primary and secondary prevention of fractures to best inform clinical decision-making. Despite guideline recommendations and calls for more screening and treatment, there are legitimate reasons for some clinicians and patients to opt out."

And an older arcticle, says: "Bottom line. Bisphosphonates offer only modest benefits in building bone and preventing fractures, and that should be considered along with the risks."
https://www.consumerreports.org/cro/2012/04/popular-osteoporosis-drugs-come-with-mounting-concerns/index.htm
Do some research on the benefits of high doses of vitamin K2, which I recently started taking. In Japan it's prescribed for osteoporosis and has shown positive results. There are some conversations about it on this site and on-line. Here's one article: https://www.lifeextension.com/wellness/vitamins/vitamin-k-benefits

judithsmiles, we basically have two types of medications for osteoporosis. The anabolic that assemble complex proteins to build new bone and antiresorptive that prevent the resorption or loss of damaged bone.
All the bisphosphonates Reclast, Fosamax etc and Prolia are antiresorptive. The stop bone from breaking down. The stop damaged bone from breaking down and by collecting this bone, they increase bone density. Which does make your bones less likely to fracture. This bone is more brittle has fewer blood vessels and nerves, creating some risks for atypical femur fracture and osteonecrosis of the jaw.
Evenity is the drug considered both antiresorptive and anabolic. The bone building happens in the first three to six months and after the drug acts more as an antiresorptive.
Forteo and Tymlos are considered the anabolic (my favorites). They replicate the normal function of bone. They encourage the breakdown of fissured and otherwise damaged bone and facilitate the build up of new remodeled bone.
Both Prolia and Evenity add new bone on top of damaged bone.
Some Internal Medicine doctors understand the drugs and you might ask yours to if they would consider prescribing Forteo.
You might also ask if they will order bone markers. Some drugs don't work for some of us. And some of us end up on drugs for years that are not protecting our bones. Bone markers before the medication and after a month or two will show you whether you should keep taking the medication.
Keep posting before you decide so we can warn you about the dreaded side effects.
Best wishes

judithsmiles, we basically have two types of medications for osteoporosis. The anabolic that assemble complex proteins to build new bone and antiresorptive that prevent the resorption or loss of damaged bone.
All the bisphosphonates Reclast, Fosamax etc and Prolia are antiresorptive. The stop bone from breaking down. The stop damaged bone from breaking down and by collecting this bone, they increase bone density. Which does make your bones less likely to fracture. This bone is more brittle has fewer blood vessels and nerves, creating some risks for atypical femur fracture and osteonecrosis of the jaw.
Evenity is the drug considered both antiresorptive and anabolic. The bone building happens in the first three to six months and after the drug acts more as an antiresorptive.
Forteo and Tymlos are considered the anabolic (my favorites). They replicate the normal function of bone. They encourage the breakdown of fissured and otherwise damaged bone and facilitate the build up of new remodeled bone.
Both Prolia and Evenity add new bone on top of damaged bone.
Some Internal Medicine doctors understand the drugs and you might ask yours to if they would consider prescribing Forteo.
You might also ask if they will order bone markers. Some drugs don't work for some of us. And some of us end up on drugs for years that are not protecting our bones. Bone markers before the medication and after a month or two will show you whether you should keep taking the medication.
Keep posting before you decide so we can warn you about the dreaded side effects.
Best wishes

@daisy17 thank you so much for this information. It is really helpful as I work toward a decision about taking reclast. Both my PCP and the Endrochonologist are pushing quite strongly for me to take this. I am very hesitant. The material you provided is very helpful. Thank you.

@judithsmiles This is a good layman's overview of osteoporosis:
https://my.bone-guide.workers.dev/

@njx58 Thank you so much for this!

DEXA or DXA is the most common bone density testing. Did you have REMs, QCT or QUS.

I don't know for sure but usually doctors start off with an oral medication. There's a "pecking order" with meds where insurance may not cover a more expensive injectable or infusion unless you failed to tolerate the first line drug.

In my case I had mild osteoporosis 2 years ago and chose to start with Boniva, not Fosamax. My regular PCP prescribed it. They are both the same class but Boniva is once a month and Fosamax is once a week. I had gastritis after 4 months and went off it.

After I went off the Boniva, I told my PCP that I would hold off on seeing a specialist until after my next Dexa scan and that I would take calcium supplements to see if that helped. It didn't. My follow up Dexa showed severe osteoporosis. My scores had deteriorated significantly just in 2 years. I was referred to a rheumatologist at that point. The rheumatologist prescribed Evenity. I'm taking it without any issue.

@oconnorbg You are welcome. My Dr disagrees with my decision to refuse drugs at this time, but respects my opinion. He said he has other patients who feel as I do. Just FYI, my DEXA scores are -2.7 in my hips and -4,1 in my spine.

Also remember that bone changes very slowly, so you have time to become informed. Personally, I would try Fosamax before Reclast based on the side effects with Reclast that I've read about on this site.

I'll also mention that due to my reluctance to take Fosamax, my endocrinologist said he would prescribe it at 1/2 strength for me, saying that lower dose has been shown to be effective. If you decide to take a med, you could ask your Dr about trying that and see if you have any side effects from that lower dose. If not, you could try changing to the full dose later.

AI Assist says this on Fosamax: "The usual dosage for treating osteoporosis with Fosamax (alendronate) is 70 mg once weekly or 10 mg once daily. For prevention, the recommended dose is 35 mg once weekly or 5 mg once daily."

Also, on Facebook there is a helpful site "Brick House Bones with Dr. Lisa Moore, DPT". She is a physical therapist specializing in osteoporosis. Her site has lots of helpful info and links to free exercise videos.