@maloc

There is no prescribed sequencing. Everyone is different and has their own unique medical history. It in my case I find it important to do my own research, listen to other's experiences and outcomes so that I can be my own advocate. When I go to my providers I always have a list of questions. So, for instance Please tell me what factors did you consider to recommend this particular drug, what is the treatment plan that you are recommending and what are you seeing that would factor into the sequencing these drugs?

@maloc Sequencing is a little complicated, at least I find it so. If you start with a bisphosphonate such as Reclast, it will blunt the effectiveness of an anabolic drug, such as Tymlos, Forteo or Evenity, that might be prescribed later. Those drugs are bone-builders. They usually are prescribed for more severe cases of osteoporosis. The conundrum is that if your T-scores worsen or you fracture while on the bisphosphonate and you/your doctor want to use a bone builder for improvement, the bisphosphonate you tried first will blunt the effectiveness of a bone-builder. I have two conflicting thoughts on this: (1) if T-scores are osteopenia or just mildly osteoporotic, take no drugs at this point. If/when things worsen, start with one of the anabolics. (2) take an anabolic even if T-scores are osteopenia or just mildly osteoporotic and build as much bone as you can while still in the early stages with the likely outcome (IMHO) of getting back into normal range. Then a bisphosphonate for maintenance afterwards, duration of which to be determined by monitoring by DEXA and/or blood turnover markers, The second course may not be possible though because insurance companies generally want to try the less expensive "little guns" before approving the much more costly "big guns."

In my case, I was diagnosed with severe osteoporosis at -3.9 in my spine (hip numbers osteopenia or just mildly osteoporotic). I was diagnosed after my second wrist break. I was prescribed alendronate, which I took for 3.5 years. In the interim I learned about the other drugs on my own. Had I known about them at the time, I would have asked to be put on a bone builder from the get-go. I am now in month 20 of teriparitide (Forteo). My DEXA in March showed 4.6% improvement in spine which is OK but still leaves me at -3.5 with a still degraded bone structure. I think I would have had better results had I not been on alendronate first.

You might find this article useful
https://medshadow.org/conditions-treatments/osteopenia-osteoporosis/osteoporosis-treatment-screening-medications/

@maloc There are several research papers and presentations/videos by doctors and researchers about osteoporosis drug sequencing or order to take them. I don't want to post them all here, but search YouTube for Dr. Michael Lewiecki or Dr. Benjamin Leder for lots of detailed information.

For a quicker overview of sequencing try this one:
Osteoporosis Treatment: Best Order for Medications Explained