Hello @yani2023,
I had a liver transplant in August 2020. I had a bone density scan six months later which showed moderate severe osteoporosis in my lumbar spine, and mild osteoporosis in my hip and neck. I saw an endocrinologist a couple months later who wanted me to have infusions of Reclast. Like you I was concerned about drug interactions and in this case Reclast and Tacrolimus together can have major impacts on the kidneys. So I opted to try Alendronate.

I take it once a week upon awakening at 5 am with a glass of water. I wait for at least 45 minutes until I have coffee. I take my morning immunosuppressants at 8:30 am. So far this regimen has worked ok for me. My labs are good and no side effects from the Alendronate.

I also take 1200 mgs calcium carbonate, 2000 iu Vitamin D, Omega oils, and walk/hike 3-5 miles/day.

I had another bone density scan last spring. My bone mineral density increased nearly 14% in my hip and neck, so I’m now classified as having osteopenia there. In my lumbar it rose 8%, so I’m still at a moderately severe level in my back. But I’m definitely pleased it’s improved.

I know it’s a tough decision, but I knew if I didn’t try the medication my osteoporosis would probably continue to get worse, especially with the side effects of Tacrolimus. I also didn’t want to limit my outdoor activities due to fear of falling. While I still have to be careful, I’m hopeful my bone minerals will keep improving.