Are we overdosing Reclast???

@mayblin I read your reply with great interest because you are the only person, besides my endocrinologist, who mentioned the 280ng/L CTX reading as the key number in evaluating the need for another Reclast infusion. You also mentioned another analysis used 212.

I recently saw my endocrinologist who looked at my CTX scores (baseline plus 2 additional readings) and saw my most recent CTX was 283. She said that she recommended another Reclast infusion now. Had I taken her advice, I would be doing one now, but I'd prefer to wait a full year since my original and first Reclast infusion in October 2025. I'd like another Dexa scan before deciding about when to do the next infusion, but that will depend on Medicare coverage since it's not been 2 years since my last one.

When I asked her about referring to 280 as a significant threshold, she said it was used in Europe. With your more specific reference to ECTS I could find out more about this group which describes itself this way:
The European Calcified Tissue Society (ECTS) is the major organisation in Europe for researchers and clinicians working in the musculoskeletal field.
https://ectsoc.org/about-ects/
If you can provide a reference to the ECTS referral to the 280, I'd really appreciate it. But if you can't do that, no worries. In looking for that, however, I did find
"A position statement by ECTS on Discontinuation of Denosumab therapy for osteoporosis – by Carola Zillikens."
While no mention of that 280 is in this statement, this comment caught my attention even if the number of women was incredibly small:
"A recent very small study of six women with postmenopausal osteoporosis who had been treated with denosumab for 7 years showed that a single infusion of zoledronic acid was not able to prevent BMD loss at the femur. Studies to investigate the optimal timing of starting i.v. bisphosphonates as well as on the duration of this post-treatment period are clearly needed."
https://ectsoc.org/a-position-statement-by-ects-on-discontinuation-of-denosumab-therapy-for-osteoporosis-by-carola-zillikens/
Thank you for providing this information!

@gravity3

You have a very open minded endo. I've decided to stop all Rx osteo therapies after my 2 years on Forteo because my endo refuses to modify the dosage or time frame of RECLAST infusion. I'm risking the loss of the meager benefits of Forteo because of the rigid protocols for Reclast.
For now, I'm going all out on Functional Medicine, which is very costly but with the intention of getting to the root cause of osteoporosis and a few other health issues. I am going into this with eyes wide open and after thoroughly studying everything I've learned from this blog and other sources. I plan to get a DEXA in a year to track what's happened.

@prarysky
Here is the link for ECTS position statement: Fracture Risk and Management of Discontinuation of Denosumab Therapy:
https://academic.oup.com/jcem/article/106/1/264/5939974
It’s interesting 280ng/L (or pg/ml) corresponds to "premenopausal mean”

Grassi’s further analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC11403318/

suggests 212 ng/L as the more stringent target to actually achieve BMD stability - it did point out that it is difficult to reach.

Please bear in mind we were discussing those CTX thresholds in the context of Prolia cessation, and these numbers may not be applicable in the setting of treating osteoporosis with Reclast.

Are you using Reclast for OP treatment?

@kar50 Did you consider taking Alendronate as a follow-up?

@wilweten
Hi,
As I understand it, Alendronate is the same as Forteo, which I injected daily for 23 months. The concern is which bisphosphonate to take to lock in the gains, and none of the alternatives are reasonable for me at this time.

@kar50 Did you consider taking Alendronate as a follow-up?

I received the half dose of 2.5mg in December of 2025 and had a severe inflammatory reaction. In my case lowering the dose did not reduce my sensitivity to this medication.

I received the half dose of 2.5mg in December of 2025 and had a severe inflammatory reaction. In my case lowering the dose did not reduce my sensitivity to this medication.

@mayblin Thanks for finding these references!

I'm using Zometa (the 4 mg dose instead of the usual 5 mg Reclast dose/infusion) which was prescribed by my oncologist. Following my breast cancer diagnosis in the fall of 2024, I started on an aromatase inhibitor, letrozole, in July 2025. Because 1) that drug can lead to serious bone loss, 2) my FRAX score was relatively high although my 2025 Dexa given before I started letrozole showed osteopenia and not osteoporosis, and 3) my age of 75, my oncologist recommended I start osteoporosis medication. I could not take oral bisphosphonates, didn't want Prolia, and my estrogen-positive breast cancer ruled out anabolic meds. Hence...the Zometa.

The Zometa did what it was supposed to do in reducing my relatively high CTX at baseline but it has gradually crept back up above that 280 threshold. I, however, look at how much the CTX came down from baseline. Yes, it is going back up but I'm not sure how quickly. My endocrinologist won't order another CTX because she think it's pointless. I disagree and may order labs on my own. I'd rush out and do this except I'm a tough needle stick. The last time Quest Labs tried to draw blood, they couldn't. I usually rely on my port but that means labs only ordered by my oncologist or other doctors at the same medical center.

My endocrinologist did order another Dexa and it will be a little more than a year since the 2025 one. Unfortunately, everything I've heard that Medicare probably won't pay for the Dexa this time since it's under the 2 year interval. I know others on this site say they have been approved for Dexas sooner than every 2 years, but their diagnostic codes may be different than mine.