What are the long-term positive/negatives of taking osteoporosis meds?

They are probably suggesting Evenity monthly injections. You go to a clinic or infusion center and are given 2 shots usually in your abdomen (very tiny needle) for a year, then take something else such as Reclast to hold in the gains.
You can then take yearly Reclast infusions or try Prolia shots every 6 months. You must take something else if you stop Prolia due to a rebound effect. Your doctor needs to spend some time with you giving you all your options, discussing pros/cons of each. Also, the order in which you take osteoporosis medications matters!

Hi, @julie59 You are asking great questions. When I was first diagnosed, this group helped me navigate to some very helpful resources. I recently created this post to help others easily find them. You may find the video links helpful.
https://connect.mayoclinic.org/discussion/new-osteoporosis-diagnosis-where-to-start/

Julie 59,
a brief rundown
There are basically two classes of osteoporosis medications: antiresorptives and anabolics.
It seems like there are a lot of choices because the bisphosphonates have so many different names. Some based on whether you take them by mouth or by infusion. There are two other medications Prolia and Evenity that are also antiresorptive. The work primarily by interrupting the normal process of bone renewal by stopping the initial stage of breaking the bone down. So they increase bone density by collecting older, fissured bone.
The yearly infusion you are offered is Reclast (brand name) zoledronate (generic). It blocks the cells that break down bone effectively and collects the older bone efficiently. Generally, people are given a second infusion after a year.
Prolia is every six months. Once you start Prolia, it is difficult to quit because it it blocks and collects the cells that breakdown bone and when you stop all those acid producing cells are released on your bone and many have multiple fractures. These patients almost always take Reclast for one or two years after Prolia.
Evenity is an injection every month. It blocks the production of the cells that breakdown bone in the pre-cell stage. And adds some bone over the old. Normally followed by another medication Evenity is given twice, though now some are taking it for two years.
Then there are the anabolics: Tymlos and Forteo. They encourage the normal process of renewal of the bone. Increasing the cells that build bone and the cells that break bone down. Called remodeled bone it is the best most resilient, most integrated bone. Both medications are self given by injection with a tiny needle every day.
With all these drugs there are side effects for some individuals.
This is the best site to field questions. We welcome all questions and vary in opinion.

Hi, @gently I really appreciate the insights you share in this group. They’ve been really helpful to me along the way. It’s apparent that you are quite knowledgeable and seem to closely follow the multitude of data available. I’d love to learn more about the mechanism through which Evenity works, primarily around the building of new bone over old and how this relates to bone quality. I wonder if you could direct me to any studies you find particularly helpful with this, either here or via direct message? I’ve dug around a good bit and am still not quite clear on this. As this is the drug I’m currently taking, I’d like to understand this better. Many thanks for any pointers you are able to provide.

Actually Evenity is also considered an anabolic that builds new bone as well as an anti absorptive the last few months (of the year).

Thank you for this information.

While we wait for a response from @gently, I’d like to share this publication indicating “modeling-based bone formation” by Evenity:
https://pubmed.ncbi.nlm.nih.gov/34633116/
I’m attaching a picture below to show the modeling based bone formation over quiescent surfaces - middle part of the picture. Interesting comparison: remodeling based bone formation over remodeled surfaces (top) as in the case for teriparatide and abaloparatide.

Most of the images we see show the effect of the medications on the surface of the bone. I am far, far more concerned with the underlying structure. That is never shown.

leslie, you are so right.
The primary mechanism action with Evenity is anti resorptive. You probably already know that it targets sclerostin and prevent the cells that break bone down from developing. It blocks the normal process of bone remodeling. It does also add bone, the way that Prolia adds bone. While they are both classified as anti resorptive because of their (different) primary mechanisms, they occupy a space somewhat in between the terms anabolic and anti resorptive.
It's bone that is added scaffold-like to the outer portion of existing bone, covering fissured bone without resolving fissures or restoring blood supply.
While I wouldn't call either Prolia or Evenity anabolic, there isn't a reason to quibble over terminology. Further, since the purpose of all of these pharmaceuticals is to prevent fracture, it might be enough that they all do so.
There aren't good studies about how fast the bone added by Evenity is lost after stopping the medications. And I hope there won't be case reports because we should all be guided into a follow up medication.
The bone added is also heavy bone unarticulated by cannulation needed to change the bone internally according to our usual activities. This bone can't be as resilient as anabolic or parathyroid-bone.
I appreciate your post

Look at the pictures on the Evenity website. BTW, Evenity does claim to be anabolic and to reduce bone loss.

http://www.evenity.com/about-evenity