Has anyone been prescribed Alendronate with a spine BMD of -3.0?

The proper sequence is bone builder first, then bisphosphonate. The bone builders do not work as well after alendronate, according to my doc and other sources.

Many are doing Evenity, which is once a month for a year and is a potent bone builder that also has some anti-resorptive properties, like alendronate, though less so (again according to my doc and other sources).

I have done Tymlos for almost two years. Many of us are using the "clicks" on the injection pen to adjust dose. If you are scared you can start with 2 out of 8 clicks and move up to whatever level you can tolerate. My doc is totally on board with this. The injections are no big deal, like brushing my teeth.

I will chime in here. The alendronate is what the insurance companies push because it’s cheaper and often they won’t cover the bone builders (Tymlos Forteo Evenity)unless you fail on Alendronate. But @windyshores is correct and I applaud your Endocrinologist for wanting you to do the bone builders first.
Good luck to you in coming to your decision!!!

@ans insurance policies need to change, as I am sure we all agree. All the doctors I have talked to are outraged at the policy of requiring bisphosphonates or Prolia first, and many PCP's seem unaware of the issue. I would love to hear whether endocrinologist advocacy makes any difference for anyone.

I totally agree with that you should start with The proper sequence of the bone builder first, then bisphosphonate. I just started Evenity and are afraid of the side effects who isn’t. My T spine score is -4.6. It’s a fight with the insurance companies but your Md will fight for you. I self inject and believe me it’s no big deal. I do pay $560. A month out of pocket due to I’m in what they call the donut hole. The Evenity is only for 1 year.

I’m very confused, are you saying that the required protocol of Fosamax and Prolia first, is not the best path to follow, that a patient should proceed directly to Reclast?

@cez Fosamax and Reclast are both bisphosphonates. So Reclast is not good to start with either (see note at the bottom.)

You might want to read McCormick's book "Great Bones," search online for Dr. Ben Leder's (MGH) video on sequencing and combinations of meds, or ask your own endocrinologist. The idea is that it is better to do bone builders first (Forteo, Tymlos, Evenity) and then "lock in" gains with a bisphosphonate or Prolia (my doc does not use Prolia because it is tricky to get off of it w/out bone loss). The other part of this is that use of bisphosphonates or Prolia first may affect the effectiveness of the bone builders.

ps an exception is for breast cancer, when Reclast or Zometa is given along with hormonal meds

Thank you!
I guess I better continue to do my due diligence, bc there is so much to read and try to understand.
Today was my 2nd endocrinologist appointment.
1st appointment, Prolia or Reclast was offered. I asked for 6 months to think about it.
Today, 2nd appointment - again I refused treatment (Prolia or Reclast) saying I was not ready to commit to what might be adverse side effects from the rx.
She said, if we do one injection of the Prolia and you don’t like it, we won’t do any more.
Additionally answering my question of, “after one injection and I choose to discontinue any further treatment, what’s situation have I put myself (my bones) in?
“Probably ok to do nothing further.”
I definitely need to do more research before i feel comfortable starting any of the Osteoporosis medications.
Another follow up appointment in 6 months, maybe I’ll be ready then.
I will look at the book you recommended. Thank you.

I am new to this, but I'm a fan of getting several diff. med. opinions if possible. Of course I have two drs. who have completely diff. opinions about what I should take. One said actonel and the other said forteo tho medicare does not cover that right away I was told. Still undecided. What I didn't ask and should have, was, why did they think either one of those was best, so food for thought. good luck. L

Actonel is a bisphosphonate and anti-resorptive that affects bone turnover.

Forteo is a bone builder via the parathyroid.

Insurance wants us to take bisphosponates first but they are not powerful bone builders and also may affect the effectiveness of bone builders in the future.

Forteo patient assistance may help with financing the med if insurance won't cover.

See McCormick's book "Great Bones" and the video online by Dr. Ben Leder on sequencing and combinations, or talk with the doc who wants Forteo. Maybe they will advocate for you with insurance depending on DEXA scores and fracture risk.

Very interesting summary. Thanks so much, Windyshores. I plan to investigate this further as well. Great information on this site.