Reclast after Fosamax

Posted by chiefsmom @chiefsmom, 4 days ago

I was compliant with taking Fosamax weekly (30 minutes before food or meds/vitamins) for 5 years, ending 3/9/2024. My hip T score initially improved but now it is back where I started at -2.5. My lumbar T score slowly declined during the whole treatment, which is disappointing as Fosamax is supposed to have more benefit for the spine. It is now -2.7 (was -2.2 before Fosamax). My rheumatologist recommended Prolia as the next step, but I am very concerned about the high risk of multiple vertebral fractures that can occur if for some reason I needed to stop Prolia, as I have moderate to advanced scoliosis. She offered Reclast as an alternative to Prolia and feels I don't need an anabolic right now. Has anyone followed this sequence - Fosamax and then Reclast - without taking any other OP meds and no HRT? Did Reclast increase your bone density in hip or spine when Fosamax did not? If so, please share your T scores before and after Reclast if you have them. Thanks.

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mayblin | @mayblin | 4 days ago

So it sounds like you had about a 1.5yr drug holiday after 5yrs on Fosamax, and lost some BMD during that time, correct? Was the DEXA done on the same machine for comparison?

Have secondary causes of osteoporosis been checked? What’s your FRAX score like?

Checking bone turnover markers (CTX, P1NP) might be helpful. If CTX is still low, maybe continue the drug holiday with close monitoring. If it starts to tick up, why not consider a PTH analog like Forteo or Tymlos?

I’d ask if it’s a good idea to suppress bone turnover for extended periods of time (5+ years), even with short holidays, and seek a second opinion before deciding on the next step.

redlo | @redlo | 3 days ago

Agree with the above comment. I took fosamax with limited results. It was explained to me that you want to build the bone with an anabolic Forteo and then take take a reclast Fosmax for a year to protect the growth. And if you're able after a year of reclast maintain it with diet and exercise.