Drug holiday between Reclast and more powerful bone medications

I believe that you have to allow the bisphosphonates to wear off to gain the benefits of the anabolic drugs. My osteoporosis doc had me start with Tymlos as he noted it’s not as effective if on a bisphosphonate immediately prior (i believe they “coat” the bone, which blunts the effect of the anabolic). After my two years on Tymlos I then did a reclast infusion. I will have two more annual reclast infusions and then do a drug holiday for several years. They will test my bone markers and when it starts to show a decline I will then start the next drug (yet TBD). My sister is on a bisohosphonate as well, her osteo doc is having her do five years max on it (note it’s not as powerful as reclast - I was told five years of Fosomax or 3 annual reclast infusions). She then has a 3-5 year drug holiday then will go back on the bisphosphonate when her bone markers start to decline. Too much continuous time on bisphosphonate has been found they become less effective and can cause other issues such as brittle bones and atypical fractures. All of the drugs can cause issues with continuous use over a certain number of years. Drug holidays are becoming more common as they have found drugs like Reclast remain in your system for many years. I would ensure your doc is testing however so you can monitor when it’s time to start the next treatment. I believe they commonly want at least a year off bisphosphonates to gain the benefits of the anabolics like Tymlos, Forteo and (from what I understand 3 years after reclast or 2 after a daily bisphosphonate are pretty common). Evenity may be in my future someday, we discussed how I would need to wait at least a year after bisphosphonates (likely at least 2 or 3 after Reclast to receive the most benefit from the drug). The timing and order of the drugs is incredibly important. I would be cautious doing more time on Reclast. Drug holidays have become more common lately as numerous studies are now showing the bisphosphonates build up in your system and can take five+ years to fully clear as well as the issues they are finding with continuous use. If you inquire with your osteo doc as to the reasoning he can likely explain why and share some of the studies with you

Thanks very much for your reply!
I treated osteopenia with Evista for decades then sought help from an endocrinologist when my results slipped into osteoporosis territory. My endocrinologist chose Reclast at that time. My options are to continue with Reclast for 2 more years for a total of 6 treatments OR switch to a more powerful medication BUT that would require a 1-2 year drug holiday.
As someone suggested, I Googled my problem and found the article: Taking a break from osteoporosis medicine: What you need to know
Based on what I learned from this article, I'm considering completing the 6 year Reclast to avoid a drug holiday at this time due to my moderate scoliosis with t7 wedge fracture and t10 rotation.

I just found out that my DEXA results were not as hoped. 1.3% increase over the hoped for 6.8% increase.
But tangentially, I found out I am insulin-resistant now. Lookie there! A big connection with that and diabetes slowing down the response to the medications. Why do WE have to be our own doctors?! do your research ladies!

@loriesco what medication are you on, did it cause the insulin resistance

Thank you for that.

I'm doubting that any of the really knowledgeable osteoporosis docs would suggest taking 6 years of Reclast. I'm guessing that you have not had your CTX scores checked regularly while taking Reclast. If one does that you can skip the simplistic formula of take Reclast every year for 3 years and then take a holiday. Tracking your bone markers and having annual DXA's can enable you to know when you would actually need another Reclast infusion.
I believe others have already stated that taking time off from Reclast would help one get benefit from a bone builder. Reclast is probably the drug that would most limit the effectiveness of a bone builder med. Anyone know of an actual study of that?

I did Tymlos I just finished my FOURTH and hopeful final Reclast infusion today. Now what? My Endro practice is constantly hiring new docs and firing and they are so hard to get into…

@mangos
Could you expand on your message regarding "I just found out that my DEXA results were not as hoped. 1.3% increase over the hoped for 6.8% increase". I may be thinking of someone else so please excuse me if I've got this all wrong. Were you taking Tymlos with or without HRT and hoping for better DEXA scan results?