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Are we overdosing Reclast???
Note: I have posted this elsewhere in comments but I don't think it was widely seen so I'm posting this here as it's own discussion.
Now to the point, YES, I think Reclast is being overdosed and that the the large dose given once a year is probably responsible for a lot of the bad side effects some people experience.
There is strong evidence in studies that lower dosages and altered infusion schedules produce very similar results and in one case superior results to the standard 5 mg dose of Reclast.
It becomes clear from studying the papers below that the motivating factors behind the 5mg yearly dose is convenience, patient compliance, money and they claim the greater good for the most people. They do not consider intelligent individualized medicine. Nor do any of these papers report anything other than temporary discomfort as a side effect. None of them seriously consider that a lower dose might be safer.
Before I list the papers supporting my argument that lower doses could be effectively and safely used I want to mention that maybe severe long term side effects are rare events and don't merit this attention. The short term flu like etc reactions are acknowledged but long term life changing side effects don't seem to be well reported for Reclast. I do not know how often or in what percentage of Reclast users these occur. Some reports could be coincidence and not due to Reclast at all. I do not know how to determine how real the threat of long term serious consequences is. So, for the purposes of this post I'm considering the serious long lasting adverse side effects of standard dosing of Reclast to be real, of unknown frequency and something to consider and try to avoid.
Here are three papers showing lower doses work just as well.
The first one compares 3 different doses and shows that 1mg does well, 2.5mg does best and 5mg does ALMOST as well as 2.5 mg. All three were one dose with result at one year.
https://academic.oup.com/jcem/article/97/1/286/2833555...
The second one alters dosing schedules depending on dosage. Combined with the paper above this is great information. They used dosages as small as 0.25mg quarterly with the same result as the large annual dose. It's behind a paywall but you can get a free account and get three free articles a month.
https://www.nejm.org/doi/pdf/10.1056/NEJMoa011807...
The third one compares 2mg to 4mg and concludes that we should stick with 4mg. BUT, if you dig into the details you see that there is reason to rethink their conclusion. Yes there is a tiny advantage to 4mg in the spine BUT there is a tiny advantage to the femur neck and total hip for the 2mg. Hardly what would make me call the 4mg superior and certainly not a significant difference. The difference in the spine is between 2mg gains 4.86% and 4mg gains 5.35%. So a gain of about 5% with either dose. As I said it flips the other way with the hips but they do not consider that even though their study shows it.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8420937/
What also needs to be considered is how often we are dosing Reclast and how the annual dose for osteoporosis may be too frequent and may be putting people at unnecessary risk of long term side effects.
I wanted to list a fourth paper showing that Reclast doesn't usually need to be given annually. That it often lasts as an effective dose for 18-24 months. I'm almost certain I saw a paper on this but I cannot find it now. What would be best IMO is to monitor CTX and only give another infusion when the CTX reaches a level indicating bone turnover is speeding up too much.
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I have finished Evenity monthly injections for one year in June 2025. I didn't start Reclast right away, so I could have a tooth extraction and implant (done yesterday). Now I wait 4 months to put a permanent tooth on the implant. My oral surgeon says not to take Reclast during these 4 months. My osteoporosis doctor says I could likely lose all my bone density gains if I don't go on Reclast now. What should I do???
@crema Wow that's unfortunate timing but it's so hard to deal with dental work and osteoporosis meds.
Before guessing at possible courses of action I'm wondering if you had a DXA before and after Evenity? If so you could have another one now to see where you are at. There is no harm imo in having DXAs more frequently in unusual situations like this. Also are you tracking blood markers as that could be useful to get an idea of how rapidly you might be losing gained bone.
Here's some initial thoughts on a possible course of action. I do realize there are issues with how helpful your doctors will be and insurance and out of pocket costs. I'm ignoring those for now.
0. Over the course of a year one would likely lose all their Evenity gains.
But after a year off from Evenity one can do Evenity again and have virtually the same gains.
1. Forget anti resorptives for now since you just had the extraction and implant.
2. Take a bone builder specifically Forteo until you are past the dental work. Forteo being known for being safe from jaw issues and maybe protective even. I have only read a tiny bit about this so don't take this as a for sure valid information.
Hopefully others will have some suggestions though you might want to do a separate post on your dilemma.
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2 ReactionsSure wish I had seen this info before Reclast IV. Had only minor cramps in first week or two, but then had major thigh spasm that resulted in a bruise about 4" by 12" and muscle pain for 10 days. A couple of weeks later I had less severe pain in the other leg for several days, and now, a week later, I have a very painful arch after a 30 minute walk around an art gallery. Will not be likely to try this ever again. Low ability to exercise may cost me more bone density than any gain from the med.
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2 ReactionsI had first ReClast IV two weeks ago. Was assured by medical staff to expect two to three day flu-like reaction and then back to normal. I took Tylenol, hydrated and followed directions for pre and post the infusion. Since then I have had strong fatigue and a sense of being unsteady. Walking any distance would be challenging. Prior to the infusion I felt “normal”; I am 82 years old and on Letrozole. Before I exercised at a gym, went to Church events. Tomorrow I will see a new PCP. Hoping she will have suggestions. Wondering if others took two, three or four weeks until recovery. I have had a back ache that seems some better but no fever or significant joint pain. Just the constant sense of fatigue.
I am 77 and prepared likewise. Sailed right through the first 2 weeks. I would recommend avoiding overdoing, and pay attention to cramps in muscles, stretching as you would for a Charley horse ASAP as you notice a muscle beginning to cramp.
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1 ReactionMight be good to note the very long original post on this, with the links attached, came out in 2024.
Knowing how many of us want answers, we sometimes take the word of a stranger putting out their advice on matters, posting a few links and offering medical answers or what we should do, in their opinion, when they are not doctors. There is so much research we can do on our own instead of taking the word of a stranger. Sharing what worked for me and what didn’t work or what side effects I’ve had or not is great to share. I really like hearing what someone else experienced. I have a friend who “plays” doctor, has even diagnosed her husband of 30 years as on the spectrum because he has a bad temper and smokes a lot of dope.
@willow5 Agreed, but it is helpful to hear what others are experiencing.
I'm rethinking my comment as I do not know how to delete it. The comment that appeared here just a few minutes ago was not intended to go to Mayo Connect.
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1 ReactionTotally agree…Reclast and so many OP meds seem to be over-dosed, causing side effects that are hard to manage….one size fits all simply doesn’t help everyone. Many people with OP are quire small and lower doses should be considered, really for many meds. The side effects so often reported are scaring many people away…Most ENDOs don’t offer other options, and leave patients on their own to deal with some life-altering side effects. That’s why we come to MayoConnect- -to gain better understanding, to learn real-life situations and possible solutions/alternatives.
That first article I have seen before but it’s from 2012, I wish there was REALLY current info bc my doc insists on 5mg. Does anyone see anything really new?