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@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/
Replies to "@maloc Sequencing is a little complicated, at least I find it so. If you start with..."
@cat1203, i didn’t respond 'well' during my 1st yr on Forteo either: at 13mo, my lumbar gain was "only" 4.9% with a slight but insignificant bmd loss at the hip and femoral neck, and that was without any prior bisphosphonate treatment. Given your 3.5yrs on Fosamax, a 4.5% gain is actually a strong biological signal.
Have you done a BTM lab recently? If they still show a robust turnover state - especially when compared to your previous labs if you had them, it may be worth discussing an extended 3rd year of Forteo with your doctor. Considering your current TBS of 1.224, staying the course could allow for continued architectural reinforcement and mineralization.
FWIW, I was actually prescribed and approved for a 3rd year of Forteo due to my seemingly "delayed" response, though I ultimately chose not to pursue it because my BTMs were too high at the time. In the end, I had wonderful gains.
Just a thought!
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@cat1203 thanks so much! I have do my due diligence about Reclast vs actonel. Your info is very helpful.