What follows Reclast/Zometa if they are first treatment?

You can start and stop Reclast as there’s no rebound like prolia.
Reclast is annually or every 2 years even. I had 1 infusion about 3 years ago and have held steady.

For bone health, Reclast is usually used for about 3 years, sometimes up to 6. During that time, the schedule can be flexible: your doctor might pause it for a “drug holiday” or space out the infusions to every 18–24 months if your DEXA scans and bone turnover markers (like CTX) look stable.

If down the line an anabolic drug becomes an option based on new data or guidance, you could take a break from Reclast, monitor your bone markers, and start the anabolic once remodeling isn’t too suppressed. I believe I read a couple of success stories on the forum.

Also, depending on your personal circumstances, you could always ask your doctor whether a reduced dose of zolendronate might be appropriate.

@leslie2121
Very good news to hear that your one infusion has kept you steady! Thank you for replying and good thoughts going forward for you.

@mayblin Thank you for this information!

I wish my oncologist was more proactive about monitoring me with bone marker turnover markers but she isn't. My primary care doctor is also unwilling to order those bone markers. I consulted with an endocrinologist who is out of the Northwestern Hospital health care network (where my oncologist and PCP are) who was willing to prescribe these bone markers for me. I wanted to have a baseline before I start the Reclast.

I plan to discuss a possible reduced dose of Reclast with my oncologist, though I'm pretty sure she will want to use the traditionally prescribed dose. The breast cancer tumor board recommendations for treatment seem to follow what they consider evidence-based practice.

I continue to learn so much from you and others on this forum!

Hi, I’m amazed that an oncologist would add Reclast into the mix, with chemo….especially for relatively mild OP…. That’s a lot for one person to endure at one time…. My docs held off from that at present, but I do have to increase exercise and PT… found supplements for the time being, and take care with diet…. Wish you the best of luck and healing !……PS if you do Reclast, consider a lower dose given slower… many people take some meds before the infusion to ward off side effects…i wonder if they ever divide the dose …??

@nycmusic
I think my oncologist and PA took one look at my FRAX score from my August 2025 DEXA and felt a 23% chance of a major osteoporotic fracture in the next 10 years was too high to ignore. Add me being on an aromatase inhibitor for years, potentially the rest of my life, and I'd definitely be rolling the dice.

I agree with you that starting Reclast a few months after finishing chemo is a lot for a body to handle. On top of that, they are recommending a CDK 4/6 inhibitor like Kisqali. I think this has been the history of cancer treatments, e.g., try meds which may prevent a recurrence until the patient cries "uncle."

Keep up with those supplements, diet, and exercise. I managed to avoid osteoporosis meds for many years, relying on exercise and supplements (especially strontium citrate, MK4 and MK7, and nattokinase) I've known I'm at risk for osteoporosis: fair, small bones, and my mom fractured her spine in her 80s. Had I not developed atrial fib, I would have preferred to stay on strontium citrate, though I don't know if you should take it at the same time as you are taking any osteoporosis medication.

I sure hope my oncologist agrees that the Reclast infusion should be slow...an hour ideally. I've found recommendations here about hydration, acetaminophen and claritin and will follow those. Will also discuss a lower dose of Reclast.

Thank you for replying and hope your regimen keeps you off meds forever or for a long time!

@prarysky thank you for your good wishes….and your supplement info as well…medicine can get complicated with possible drug interactions/side effects, including all the ingredients in your supplements !….if you feel something doesn’t work for you, it’s okay, even necessary to question it….best of luck !

@prarysky
I was watching an interview on YouTube with Dr. Keith McCormick and he stated something along these lines, if you doctor won’t work with you then maybe you should get another doctor that will. You are paying this doctor. I did exactly that. I am still searching for a new Endocrinologist that is respectful of my wishes I feel okay doing this because I am the patient and they essentially work for me. I asked the endocrinologist I saw who wanted to put me on Reclast how I would know if it was working for me? She said I’ll re-order a DEXA scan in two years. I then ask about the bone marker turnovers and she poo poo them ( I had already had both the CTX and the P1NP that my PCP ordered when I asked her to do so) Saying they wouldn’t make a bit of difference in what she is going to prescribe me. Then she berated me for having them done.

I believe I read on the sub Reddit (r/osteoporosis )that there is a place you can have your blood tested just by ordering it yourself called Jason Health Labs. You can Google this to find a lab near you. But again, it would be nice if your doctors would be compliant with your wishes.

@izziesue Sadly, there are docs who berate patients. Know what that feels like and it sure isn't good.

I can respect a doctor when they disagree with me or my requests for certain tests as long as they do not belittle me. Our doctors are, after all, the experts and their disdain for certain tests may be well-founded. I think those of us using osteoporosis drugs are trying to find ways to monitor our bone health and bone marker turnover tests seem to be part of that.

Unfortunately, there are few doctors or clinicians who specialize in bone health and are knowledgeable about bone markers. Finding them is like finding a needle in a haystack...maybe even more challenging than that!

If you can find one who will at least listen to you, you lucked out. The endocrinologist whom I saw for the first time was initially skeptical of ordering bone marker turnover tests as a baseline before I start Reclast, but when I made my case, she agreed and ordered the tests. She told me they are usually used after someone has been using certain drugs rather than before they start. That makes no sense to me.

I think we are educating the open-minded clinicians along the way. Perhaps they won't change what they consider to be evidence-based standard of care for monitoring bone health (the Dexa), but will pay closer attention to the use of bone markers. Neither my oncologist nor my primary care doc would order bone marker turnover tests, but this endocrinologist was willing to. I'm glad I found her.

Thank you for mentioning Jason Health Labs which I'll keep as a reference. Ideally, a doctor's order helps with insurance coverage but if that fails and we can afford it, getting these labs on our own is an option to know.

Thank you for your response! Hope you do find an endocrinologist you respect and can work with!

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@izziesue two years is typical but a crazy long time to be taking a powerful and for some a dangerous drug and not know if it's working. Traditional Medicare for instance will pay for DXAs every year if your doc knows how to submit it. Not sure about other insurance. I have paid for DXAs when I wanted/needed to know where I was at earlier than the 1 year limit. At my doctors the DXAs were not that expensive ($75 for each site).
Also I test CTX frequently and use Jason Health Labs for a good price. The draw and test processing is done at a local Quest Labs in my case. I think I pay $68 for blood draw and CTX test. Much thanks to Jason Health because going direct through Quest is much more expensive.