Reclast, Actonel or Evista?

I think you are wise to consult another endo. I personally couldn't deal with someone with his dismissive GOD attitude. I have an appointment with a new rheum next month. In her bio she talks about how she encourages patients to bring in any info and questions they have from their own research, support groups, etc. I hope she lives up to that.

I too was just told to take Fosamax when first diagnosed with just a one-page cursory "explainer" about osteoporosis and no info about possible side effects. I somehow came up with the idea that I could be on it for 5 years then have a drug holiday which I hoped/expected to be long, maybe even permanent. Ha! Even though your diagnosis isn't "life-threatening" as your endo put it, it's still upsetting and disheartening when you realize this is something you're going to have to manage for the rest of your life. Especially when there are potentially serious side effects with all the drugs.

In my case, I was on Fosamax for 3.5 years (with no side effects whatsoever) before I had another DEXA. I had no gains in BMD at all. It was still considered a "win" because I at least stayed stable, but the new PCPrecommended I see a specialist for a bone-building drug, and I went on Forteo, with some gain in BMD but not as much as I had hoped. So now I'd like to try Evenity because I still have severe osteoporosis and am considered a high fracture risk.

It sounds like your osteoporosis is mild (do you have your T-scores?). Since you had trouble with Fosamax, you might also with Actonel or Reclast, which also are bisphosphonates, with Reclast being the strongest. Also, if you do need to take an anabolic, bone-building drug in the future, the effect will be blunted if you've taken a bisphosphonate first (which is why I think I didn't have as much gain from Forteo as I had hoped). Evista might be a good choice for you.

I think you'll find this article helpful. https://medshadow.org/conditions-treatments/osteopenia-osteoporosis/osteoporosis-treatment-screening-medications/

Just wanted to give an update on my 2nd opinion I received today. Well technically 3rd if you count the Gynecologist who diagnosed me. First Endocrinologist basically dismissed me as you can read in my original post. This Dr was very understanding, listened to me and answered all my questions even before I asked them. She mentioned how she prefers anabolic meds before antiresorptive as you typically have better results. She also prefers Forteo, Tymlos and Evenity, but she said insurance won’t always allow those until you have a fracture. Which is ridiculous. She wants blood work done first to see why I have osteoporosis, wants to check my bone markers. Also wants to do a 24 urine collection to see how much calcium excreting. I felt like she has her ducks in a row. If insurance allows it she’d like me to go on Evenity. I mentioned Evista she said I could do that too but wants to see what bloodwork says first. So I feel like I’m in good hands.

@rudysmom Sounds like a very good doctor!! you are lucky to have a choice in endocrinologists. It can be very hard to get in to see one here. I have used both Forteo and Evista after 13 compression fractures and feel very lucky to have no further fractures since 2016

Just wanted to give an update on my 2nd opinion I received today. Well technically 3rd if you count the Gynecologist who diagnosed me. First Endocrinologist basically dismissed me as you can read in my original post. This Dr was very understanding, listened to me and answered all my questions even before I asked them. She mentioned how she prefers anabolic meds before antiresorptive as you typically have better results. She also prefers Forteo, Tymlos and Evenity, but she said insurance won’t always allow those until you have a fracture. Which is ridiculous. She wants blood work done first to see why I have osteoporosis, wants to check my bone markers. Also wants to do a 24 urine collection to see how much calcium excreting. I felt like she has her ducks in a row. If insurance allows it she’d like me to go on Evenity. I mentioned Evista she said I could do that too but wants to see what bloodwork says first. So I feel like I’m in good hands.

@rudysmom, i like your new doctor; ruling out secondary causes is a critical first step before diving into treatment. If both doctor and insurance are on board, anabolic first is the preferred strategy among specialists to "build first, then maintain". You've won half the battle already!

I was about your age at diagnosis, though my lumbar Tscore was worse. I did Forteo followed by HRT (started at age 61). You might've read my story already: https://connect.mayoclinic.org/discussion/forteo-teriparatide-followed-by-hrt-my-experience/

One advantage of HRT or raloxifene is that their effects are reversible - unlike some of the bisphosphonates - though they carry their own risks. Also, estrogen is FDA-approved for prevention rather than treatment, some doctors are more cautious with it in complex cases or for patients who've already had fractures. But i think it's worth discussing if it is feasible in your case.

@mayblin
I read your story. What great results. I think we need a thread on positive success stories like this. I wanted to ask Dr about HRT but she was giving me so much information I totally forgot! Remembered about it as I was checking out 🤦🏻‍♀️

Are you still currently on HRT? If so how long is the plan to stay on it?