@daisy17 My understanding is that they are the same. Is that incorrect? The difference is taht Reclast is a once-yearly intravenous infusion, while Fosamax is a daily or weekly pill. Reclast offers convenience, while Fosamax allows easy discontinuation if side effects occur.
@babs10 They are both bisphosphonates, but they are also different. Reclast is zoledronic acid and Fosamax is alendronate. And as you said, Fosamax is taken orally, while Reclast is given intravenously.
@njx58, you mention that insurance companies will only approve an anabolic if (a) you've already had a fracture, or (b) you can't tolerate biphosphonates, or (c) your T-score is -3.0 or worse but then say that it's better to start with Tymlos/Forteo/Evenity. But the insurance company probably wouldn't approve Tymlos/Forteo/Evenity as a first line drug.
I know that Evenity would be cost prohibitive for most people without insurance. I don't know about the other 2 drugs.
As far as selecting a medication, it's up to the doctor to decide on the best options and the patient can say no or yes but it's not the patient's decision to skip first line oral meds and go on Evenity if they have only mild osteoporosis. For one thing, Evenity has a risk of stroke and heart attack. I had to get a cardiac screening before going on this drug. I had to fail to tolerate the first line drug.
In other words, the patient doesn't just jump right to Reclast and Evenity without first trying other meds.
I would suggested holding off on medication and trying to up your diet with protein and calcium and do weight training. I would definitely do HRT if you are under 60.
@njx58, you mention that insurance companies will only approve an anabolic if (a) you've already had a fracture, or (b) you can't tolerate biphosphonates, or (c) your T-score is -3.0 or worse but then say that it's better to start with Tymlos/Forteo/Evenity. But the insurance company probably wouldn't approve Tymlos/Forteo/Evenity as a first line drug.
I know that Evenity would be cost prohibitive for most people without insurance. I don't know about the other 2 drugs.
As far as selecting a medication, it's up to the doctor to decide on the best options and the patient can say no or yes but it's not the patient's decision to skip first line oral meds and go on Evenity if they have only mild osteoporosis. For one thing, Evenity has a risk of stroke and heart attack. I had to get a cardiac screening before going on this drug. I had to fail to tolerate the first line drug.
In other words, the patient doesn't just jump right to Reclast and Evenity without first trying other meds.
@followheart87 Both my wife and I were approved for Tymlos without any prior treatment. Two different insurers. I've seen the preauthorization forms with the criteria that the doctor must fill out. A T-score of -3.0 or worse definitely passed the test for an anabolic as a first-line therapy.
@nycmusic, sure.
Of course, you know DXA the newer name (not catching on) for DEXA. Low radiation X-ray, two dimensional it registers areal (vs volumetric) measurement by a subtracting the light absorbed by soft tissue from the light absorbed by mineral in the bone. Two different wave lengths are used.
Qualitative Commuted Tomography QCT is also X-Ray with a CT scanner to yield a three dimensional image, capable of detecting osteoporosis earlier. QCT provides the most accurate measurements of bone mineral density in trabecular bone. Preferred for patients with high parathyroid hormone levels. Unlike DXA, QCT more accurately accounts for changes resulting osteophytes or vascular calcification and scoliosis. More accurate for older people. Expensive, it isn't widely used.
QUS qualitative ultrasound used mainly for the foot and hand, also a three d image
REMs is also ultrasound producing three dimensional images.
Some are finding that they have a better T score with REMS and it does address some of the failings of DEXA. Eco light has a nifty video on REMs that you can find hidden under the title of age and weight. https://iimhe.org/webinars/age-and-weight-webinar-deck/
I laughed when I finally saw your question, nycmusic, because the answer probably would sound like a crash of unfamiliar terms.
It is good to know that we can get REMs if we want to pay. I've noticed that most people have (consoling) higher bmd with REMs, but sometimes higher fragility scores.
I had a QCT early on; the results were the same as DEXA.
This is kind of interesting on DEXA https://cme.nof.org/sites/default/files/DXA%20Basics-%20Morgan_Jankowski.pdf, but I think the best time investment is the Australian on REMS.
@njx58, okay, my apologies. I assumed incorrectly that all networks work the same. In my network, a PCP wouldn't jump right to an injectable as a first line medication. They would start off with an oral medication. My PCP prescribed the oral medication and when I couldn't tolerate it, she referred me to a rheumatologist who gave me options of Forteo or Evenity. I chose Evenity.
I was told by 2 different doctors that HRT isn't recommended as it doesn't rebuild bone just prevent further bone loss. In my case, I need bone rebuilding. I also think it has to do with my age. I'm 13 yrs past menopause.
@njx58, okay, my apologies. I assumed incorrectly that all networks work the same. In my network, a PCP wouldn't jump right to an injectable as a first line medication. They would start off with an oral medication. My PCP prescribed the oral medication and when I couldn't tolerate it, she referred me to a rheumatologist who gave me options of Forteo or Evenity. I chose Evenity.
I was told by 2 different doctors that HRT isn't recommended as it doesn't rebuild bone just prevent further bone loss. In my case, I need bone rebuilding. I also think it has to do with my age. I'm 13 yrs past menopause.
I believe that the years post menopause has been discounted now as a blanket reason to deny women hrt/bhrt. I had to go to a functional medicine provider to be treated by someone who was up to date on the debunked women's health initiative study. I became menopausal at 38 and started bhrt last year at 76. Best thing I ever did for myself.
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@njx58 Thanks. This is really good. I knew that strength training (with heavy weights) and plyos were the best but now I understand why!
@babs10 They are both bisphosphonates, but they are also different. Reclast is zoledronic acid and Fosamax is alendronate. And as you said, Fosamax is taken orally, while Reclast is given intravenously.
This shows a comparison: https://www.drugs.com/compare/fosamax-vs-reclast
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2 Reactions@njx58, you mention that insurance companies will only approve an anabolic if (a) you've already had a fracture, or (b) you can't tolerate biphosphonates, or (c) your T-score is -3.0 or worse but then say that it's better to start with Tymlos/Forteo/Evenity. But the insurance company probably wouldn't approve Tymlos/Forteo/Evenity as a first line drug.
I know that Evenity would be cost prohibitive for most people without insurance. I don't know about the other 2 drugs.
As far as selecting a medication, it's up to the doctor to decide on the best options and the patient can say no or yes but it's not the patient's decision to skip first line oral meds and go on Evenity if they have only mild osteoporosis. For one thing, Evenity has a risk of stroke and heart attack. I had to get a cardiac screening before going on this drug. I had to fail to tolerate the first line drug.
In other words, the patient doesn't just jump right to Reclast and Evenity without first trying other meds.
I would suggested holding off on medication and trying to up your diet with protein and calcium and do weight training. I would definitely do HRT if you are under 60.
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Hug
1 Reaction@followheart87 Both my wife and I were approved for Tymlos without any prior treatment. Two different insurers. I've seen the preauthorization forms with the criteria that the doctor must fill out. A T-score of -3.0 or worse definitely passed the test for an anabolic as a first-line therapy.
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Hug
4 Reactions@nycmusic, sure.
Of course, you know DXA the newer name (not catching on) for DEXA. Low radiation X-ray, two dimensional it registers areal (vs volumetric) measurement by a subtracting the light absorbed by soft tissue from the light absorbed by mineral in the bone. Two different wave lengths are used.
Qualitative Commuted Tomography QCT is also X-Ray with a CT scanner to yield a three dimensional image, capable of detecting osteoporosis earlier. QCT provides the most accurate measurements of bone mineral density in trabecular bone. Preferred for patients with high parathyroid hormone levels. Unlike DXA, QCT more accurately accounts for changes resulting osteophytes or vascular calcification and scoliosis. More accurate for older people. Expensive, it isn't widely used.
QUS qualitative ultrasound used mainly for the foot and hand, also a three d image
REMs is also ultrasound producing three dimensional images.
Some are finding that they have a better T score with REMS and it does address some of the failings of DEXA. Eco light has a nifty video on REMs that you can find hidden under the title of age and weight. https://iimhe.org/webinars/age-and-weight-webinar-deck/
I laughed when I finally saw your question, nycmusic, because the answer probably would sound like a crash of unfamiliar terms.
It is good to know that we can get REMs if we want to pay. I've noticed that most people have (consoling) higher bmd with REMs, but sometimes higher fragility scores.
I had a QCT early on; the results were the same as DEXA.
This is kind of interesting on DEXA https://cme.nof.org/sites/default/files/DXA%20Basics-%20Morgan_Jankowski.pdf, but I think the best time investment is the Australian on REMS.
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Helpful -
Hug
2 Reactions@njx58, okay, my apologies. I assumed incorrectly that all networks work the same. In my network, a PCP wouldn't jump right to an injectable as a first line medication. They would start off with an oral medication. My PCP prescribed the oral medication and when I couldn't tolerate it, she referred me to a rheumatologist who gave me options of Forteo or Evenity. I chose Evenity.
I was told by 2 different doctors that HRT isn't recommended as it doesn't rebuild bone just prevent further bone loss. In my case, I need bone rebuilding. I also think it has to do with my age. I'm 13 yrs past menopause.
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1 ReactionMy dexa is over 3 and they want me on letrozole. I'm 11 yrs postmenepause and estradiol is 3
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1 Reaction@followheart87
I believe that the years post menopause has been discounted now as a blanket reason to deny women hrt/bhrt. I had to go to a functional medicine provider to be treated by someone who was up to date on the debunked women's health initiative study. I became menopausal at 38 and started bhrt last year at 76. Best thing I ever did for myself.
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Hug
4 Reactions