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Reclast over Prolia for next step - would love feedback! Thanks
Hi,
Between 2019 baseline DEXA scan and 2021 scan, my t scores went down a lot. I also experienced a family tragedy later 2019, so I was abnormally very sedentary for a good chunk of that time. So, I went on generic Boniva in Feb. 2022 with no side effects (knock on wood please!). My 2023 scan showed improvement, but my 2025 scan was closer to the 2021 results but fairly steady results between 2021 and now.
I am only sixty years old, and well because of the below femoral hip score, two doctors think I need to continue some sort of treatment versus drug holiday after fives years of Boniva which would be 2/2027.
Both sorta want me to go on Prolia though one was a bit more open to Reclast. I do NOT really want to go on Prolia at age 60 as neither doc had a definitive exit strategy for me, and I also plan to move out of state in next year or two so will need new doctors which will be stressful anyhow - without the six month clock for another shot or figuring out exit strategy with someone new.
I am not against medication, and I’m wondering if a better alternative might be to stop the pills now at 4.25 years and do one Reclast infusion and then take a drug holiday and see if that boosts my scores before committing to getting on the Prolia treadmill which really scares me….
As neither doc has a good plan for what happens “after” Prolia, but both seem to recommend more than Reclast - not sure why. I think one might consider giving Reclast after five years boniva and then holiday, whereas other I think wants some holiday first before trying Reclast but overall prefers Prolia this year. And I’m wondering if better not to finish five years and just do one infusion now as I’m really against prolia right now (might consider when older).
Thoughts, feedback, anyone had to make a similar decision? Anyone go on Prolia for a short time? Anyone had Reclast after 4-5 years Boniva? I don’t think my scores are that bad so I really would like to avoid Prolia for now if possible - is this unreasonable? Is it a pipe dream to think I could have one Reclast infusion to wrap up my first five or so years on Bisphosphonates, take a holiday, and then do something else if needed….. trying to look for the least risk/max benefit that gives me flexibility for treatments in my 70s/80s…. Really appreciate input as this is driving me crazy - and not sure why both docs so keen on Prolia as next step. Also I have not had any fractures (knock on wood please) though I did have major fall due to unfortunately tripping. I also am paranoid about dental health while on this stuff! But prolia seems to have same dental side risks….
Spine t scores
2019 -1.6
2021 -2.4
2023 -2.4
2025 -2.3
Total Hip
2019 -1.2
2021 -1.4
2023 -1.1
2025 -1.3
Femoral Neck
2019 -2.0
2021 -2.5
2023 -2.3
2025 -2.6
Thank you so much in advance for any feedback…
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I don't have a direct answer for you, but I am kind of in the same boat. I am finishing Evenity in November and will need to move on to something else. I also do not want to go on Prolia. I don't like what I hear about it. My choices are Reclast and Forteo. I like the idea of a once a year injection vs. weekly pills. I'm curious to see what others suggest.
@mays12345678 your scores are great. You mostly have osteopenia, only slightly osteoporotic in your femoral neck. I have not been on your particular drug path, so I can't comment from personal experience about your proposed treatment at this point, but no, I don't think it's "a pipe dream to think I could have one Reclast infusion to wrap up my first five or so years on Bisphosphonates, take a holiday, and then do something else if needed….." I think that makes perfect sense and is what I would do and advocate for. I too want to avoid Prolia and would only consider it for later in life ... if then.
I had Prolia injections for 9.5 years with no side effects and excellent results. My numbers indicated osteopenia at the end of the course after starting with significant osteoporosis at the age of 64. Reclast was recommended to preserve the bone regrowth. I have had one infusion followed by 5 days of terrible side effects. My endocrinologist and i are discussing what to do next.
Have you tried HRT and lifestyle changes? There is a lot you may be able to do while you take a break from medication.
Speaking for myself, I would not go on Prolia at your age because of the requirement to stay on it for years or risk a fracture cascade.
I did a year of Evenity followed by a Reclast infusion. I had a vertebral compression fracture 2.5 years ago after being on alendronate for over five years. I still gained more than 30% in my spine despite the years of bisphosphonate treatment.
Evenity might be an option for you in a couple of years.
So hi again, thank you for the respsonses. So I originally agreed to go on the generic Boniva in 2021 because there was such a decline between 2019 and 2021. I probably also hit final menopause around 2019 - never had any bad symptoms from it. So I have got my doc to agree that Prolia is not the right choice for me at this time. Since I have been very steady on the Boniva but my hip is still in osteoporosis, they are recommending a single reclast infusion before the holiday. I’m leaning this way because I think I would have a better “drug holiday” hoping the Reclast keeps me stable for a few years…. Versus another significant decline after just stopping Boniva which I have read is weaker than Fosomax. My Mom has several Reclast infusions with no side effects, but I of course worry about the side effects but I also don’t want to break hip! My goal though is after a drug holiday, if my scores decline again to try to go on a bone builder. like forteo…. As it seems it wouldn’t be good to go on bone builder directly due to the blunted impact due to time on boniva. I guess it comes down to just going for it - having the single infusion to wrap up five and a quarter years ( 4.25 yrs oral, followed by one infusion) and then take holiday - hoping Reclast keeps me steady for a few years or just take a holiday now and check in a year but not sure if that would just make me worry more as heard Boniva gets out of system faster than fosomax (spelling wrong.). And then at that point if scores low, try a bone builder. My mom did have DCIS breast cancer at 70, heart issues run in family so not keen on HRT or Evenity…. Anyhow I’m leaning towards the one reclast to kinda maintain the stability have gotten from boniva. Thoughts? No easy decisions here :-(. I do lift weights, try to eat well, etc. osteoporosis does run in family
As if I can manage the one reclast infusion, was thinking I can just have a little break from constantly thinking about this and take the drug holiday - and maybe restart with a bone builder in a few years. But again, u never know about side effects…. And I would pray jsut don’t have any dental emergencies for a while.
If I just took a holiday without the reclast first…. I would be bummed if my scores dropped immediately as if the four years on oral weren’t worth it…. As I’d like a mini break from meds!
@mays12345678
For what it's worth, I had a Reclast infusion (no side effects) at the end of 2023 and have remained stable through '24' and '25. My endos (2) will decide what to recommend after my scan in November however one implied that the infusion would begin to be less effective by the end of year three. She only suggested that only after I asked about the 10 year, 2 infusion study that was published.
Anyway we'll see if she's correct in November.
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1 Reaction@mays12345678 Bisphosphonates can blunt the effect of the anabolics but it isn’t always the case. I did over five years of Fosamax and still had success doing a year of Evenity starting 14 months after stopping Fosamax. My lumbar spine density improved by 30%.