Newly diagnosed with osteoporosis.

Will your insurance cover an anabolic if your doctor supports it as a starting point. It is understood now that gains from an anabolic can be blunted if one has started treatment with a bisphosphonate. However, I am not a medical professional and I don't know your medical history. Sequencing is quite important with osteoporosis drugs.

Maybe , hold off briefly— do some research, line up a 2nd opinion, if this doc is not offering alternatives. Wish you good luck !

Is your doctor an endocrinologist.
I'd want a medication that builds bone.
But, you could probably get around the reflux with an infused bisphosphonate.
Your doctor may have been prescribing Fosamax for many years, and might be unaware of the newer wisdom about starting with an anabolic drug.
I'm sorry about your diagnosis, welcome aboard.
It you tell us more--your T scores, or how you feeling--any pain, We'll keep responding.

Sadly insurance companies often when approve a drug until you have tried lower tier drugs and they cause problems. Unfortunately even infused bisphosphonates can cause reflux as well.

Endo started me on Fosamax at first appointment. The only other drug discussed was Reclast and a once-a-year infusion scared me a lot (no stopping if you have a reaction/side effects) thus I "chose" Fosamax. He mentioned briefly he didn't like Prolia as you are "on it for life". Never heard the term bone builder or anabolic. I did end up on Reclast after 8 months of Fosamax (not good enough gains), I should know April/May if Reclast improved my osteoporosis. Something I learned over the past almost 2 years is that (shockingly!) these drugs may not do much. Prepare for that. Apparently not getting worse is a win. And yes, insurance companies do dictate what drugs the doctors get to prescribe sometimes; and it is more economical to try the older and/or cheaper first. I would like a choice; I would like my doctor to be able to prescribe the best solution out there and then I can decide if I can afford out of pocket for drugs insurance won't cover.

@jozer

Are you seeing an endocrinologist or a physician who is trained in treatment of Osteoporosis? Do your own research so that you can engage you provider in meaningful discussions about the types of drugs available, their function and possible side effects along with treatment plan and sequencing.

What are your DEXA scores and have you had any fractures?

Like you, my doctor recommended Fosamax (I can't take Tymlos or Forteo due to parathyroid issues). I have severe osteoporosis and decided not to take it based on articles I read that said it offers minimal fracture prevention benefits in postmenopausal women without a prior fracture or vertebral compression. It does make your DEXA numbers better because you retain old bone. The only reason I'd consider a bone drug was if it offered considerable fracture prevention, because isn't that the reason for taking a medication?

There are many articles about studies done on this, here is one: https://www.amjmed.com/article/S0002-9343(24)00101-3/fulltext
The last paragraph offers a summary of findings: "for patients with osteoporosis based on bone density alone, treatment benefits are less certain. Hip fracture risk reduction is modest and not supported in patients without a history of fracture. Reductions in vertebral fractures are substantial regardless of baseline risk, but whether these reductions correspond to less chronic pain and disability is unclear. Clinical evidence is weaker for newer agents. Future guidelines and reviews on osteoporosis treatment should clearly distinguish between primary and secondary prevention of fractures to best inform clinical decision-making. Despite guideline recommendations and calls for more screening and treatment, there are legitimate reasons for some clinicians and patients to opt out."

And an older arcticle, says: "Bottom line. Bisphosphonates offer only modest benefits in building bone and preventing fractures, and that should be considered along with the risks."
https://www.consumerreports.org/cro/2012/04/popular-osteoporosis-drugs-come-with-mounting-concerns/index.htm
Do some research on the benefits of high doses of vitamin K2, which I recently started taking. In Japan it's prescribed for osteoporosis and has shown positive results. There are some conversations about it on this site and on-line. Here's one article: https://www.lifeextension.com/wellness/vitamins/vitamin-k-benefits

@gravity3 Anabolics need to be followed by a bisphosphonate to lock in gains.

@gravity3 I am seeing an endocrinologist referred by my PCP after DEXA results. First appointment I didn’t know enough about osteoporosis or its treatment to ask intelligent questions. Saw 3 more osteoporosis (after 8 months of fosamax and before reclast infusion)“specialists” (gyne, orthopedic surgeon, rheumatologist), gyne and orthopedic do not treat, rheumatologist said she would have started bone builders first. Creative field!

Thanks for sharing your experience. What are the bone builders? Is that what the reclast infusion was? I'm such a newbie!