Does reduced dose of alendronate reduce side effects

Good question! I wondered the exact same thing. I’m not on a bone building drug as my insurance won’t cover it, because I haven’t fracture and my scores aren’t severe. My Dr is appealing insurance but I know they won’t let me take Evenity or the others first. So I’ll do Alendronate. Even though I tried it a couple years ago and had severe back pain 2 nights a week, I’ll take my chance with that over Reclast or prolia. I just started HRT and was wondering if I could do 35mg of Alendrodrate with it. They both stop bone loss so I’m hoping doing 35mg will lessen back pain.

My rheumatologist is actually the one who said there could be a lower dose of fosomax given (35mg) if a woman is on HRT.
That’s what got me started asking about this .
I started on the 70 mg of fosomax ( it’s only been 2 weeks) but dr said I should let her know if I go on HRT so she can lower the fosomax dose. It’s a tough decision about HRT for me. My gynecologist is risk averse about me going back on HRT (I’m 65 and already did HRT for 5 years prior to starting Tymlos ) I stopped HRT then.
I might get a second opinion . But I wonder if it’s redundant to take fosomax for my bones and HRT ( only reason would be for my bones ) I just have fear about the jaw and femur fracture rare side effects of fosomax) if a lower dose and less time on it would guarantee that I won’t have those awful side effects I’d be at peace with taking fosomax .

Adding on to my comment - risks of HRT for me , my dr says is mainly risk of blood clot and risk of breast cancer .
( also scary stuff)

@2024tymloshelp
Below is a video Dr Doug Lucas talks about HRT and biophosonates. I mentioned I just started HRT and I use the gel form, would have done patch but they’re hard to come by where I live. The HRT gel, patch and cream bypass your liver so there is no increased risk of blood clots or stroke. I signed up Midi Health and they are the ones who prescribed it for me. Maybe set up an appointment with them and see what they have to say. The appointments are all virtual, which is a huge plus at least for me.

@2024tymloshelp Those side effects are rare, and the chances are reduced further if you follow the "drug holiday" protocol. There was a Chinese study that compared taking the 70mg dose every other week instead of every week; both groups had similar BMD gains after a year,

This is helpful !
I’ll look for that study .
Seems to be traditional doctors who treat osteoporosis these days tend to only treat based on “ studies proven /facts”
I guess to avoid law suits . Like in the case of HRT they will say “ studies have shown HRT maintains bone” but dr said “there aren’t studies to show HRT improves bone “

Curious what dose estradiol you are on ?
I was told .05 is what’s needed to help the bones . - but I was on only .025 gel and it kept my bones steady for 5 years. Again, doctors only seem to want to treat based on proven factual study results . The problem is there aren’t enough studies being done in this issue of HRT and bone

@2024tymloshelp
I’m on .05 HRT gel along with 100mg Progesterone

As mentioned, these side effects are rare and most knowledgeable doctors will keep you on it for a shorter period now (max 3 years). I took it for over five years and avoided atypical femur fracture and osteonecrosis but I did end up fracturing my T8 vertebra.

Most of the people I've read that had issues were on it for many years (10, 18 years). Of course, there is always an exception.

If I was starting over with treatment, I would take the full dose for 2 years and make sure that my T-scores improved. I'd also insist on measuring my baseline CTX and doing regular follow up measurements to make sure it wasn't depressed too much by the Fosamax.

Fosamax worked very well for the first 2 years I was on it then it stopped and my bone density actually decreased at year 4. My PCP was prescribing it and she really wasn't paying attention. If you can get someone more knowledgeable to prescribe it, or a referral to an endocrinologist, they can monitor you more closely.

This is very helpful. Thank you