Well this is exactly the problem and you articulated it really well @serious
This is an issue that will hopefully get doctors to prescribe meds differently, not for osteopenia or even early osteoporosis. If we are 80, there is not problem, but otherwise!

There are also issues with sequencing. According to my doc, it should probably go Tymlos or Forteo, then Evenity if needed (once studies prove this), then Reclast to "lock in." Docs are told by insurance to prescribe bisphosphonates or Prolia first, and the reality is that these anti-resorptives affect the effectiveness of the bone building meds.

Forteo has been approved for more than 2 years and Tymlos may follow. There is a study on Forteo use for 3 years, according to my endo.

My docs will not use Prolia unless absolutely needed- if a person's kidneys cannot handle Reclast, for instanc. Dr. McCormick and my doc say that Tymlos and Forteo don't work after Prolia so you only have Reclast to switch to. They said you also cannot do Evenity after Prolia, only the other way around.

Reclast stays in the system a long time so with proper monitoring, we might be able to take med breaks between infusions and even try some more holistic methods if our bone density has improved enough for that to be safe to try. My doc says in the future I could also return to a bone builder if needed.

Meanwhile I am purchasing hip pads and cleats for ice, avoiding opening windows or lifting while leaning and generally trying to stay safe!