Reclast over Prolia for next step - would love feedback! Thanks

Hi,

Between 2019 baseline DEXA scan and 2021 scan, my t scores went down a lot. I also experienced a family tragedy later 2019, so I was abnormally very sedentary for a good chunk of that time. So, I went on generic Boniva in Feb. 2022 with no side effects (knock on wood please!). My 2023 scan showed improvement, but my 2025 scan was closer to the 2021 results but fairly steady results between 2021 and now.

I am only sixty years old, and well because of the below femoral hip score, two doctors think I need to continue some sort of treatment versus drug holiday after fives years of Boniva which would be 2/2027.
Both sorta want me to go on Prolia though one was a bit more open to Reclast. I do NOT really want to go on Prolia at age 60 as neither doc had a definitive exit strategy for me, and I also plan to move out of state in next year or two so will need new doctors which will be stressful anyhow - without the six month clock for another shot or figuring out exit strategy with someone new.

I am not against medication, and I’m wondering if a better alternative might be to stop the pills now at 4.25 years and do one Reclast infusion and then take a drug holiday and see if that boosts my scores before committing to getting on the Prolia treadmill which really scares me….

As neither doc has a good plan for what happens “after” Prolia, but both seem to recommend more than Reclast - not sure why. I think one might consider giving Reclast after five years boniva and then holiday, whereas other I think wants some holiday first before trying Reclast but overall prefers Prolia this year. And I’m wondering if better not to finish five years and just do one infusion now as I’m really against prolia right now (might consider when older).

Thoughts, feedback, anyone had to make a similar decision? Anyone go on Prolia for a short time? Anyone had Reclast after 4-5 years Boniva? I don’t think my scores are that bad so I really would like to avoid Prolia for now if possible - is this unreasonable? Is it a pipe dream to think I could have one Reclast infusion to wrap up my first five or so years on Bisphosphonates, take a holiday, and then do something else if needed….. trying to look for the least risk/max benefit that gives me flexibility for treatments in my 70s/80s…. Really appreciate input as this is driving me crazy - and not sure why both docs so keen on Prolia as next step. Also I have not had any fractures (knock on wood please) though I did have major fall due to unfortunately tripping. I also am paranoid about dental health while on this stuff! But prolia seems to have same dental side risks….

Spine t scores
2019 -1.6
2021 -2.4
2023 -2.4
2025 -2.3

Total Hip
2019 -1.2
2021 -1.4
2023 -1.1
2025 -1.3

Femoral Neck
2019 -2.0
2021 -2.5
2023 -2.3
2025 -2.6

Thank you so much in advance for any feedback…