Medication following Evenity- Reclast vs Prolia?

@daph I posted on the differences above too. McCormick relies a lot on CTX and P1NP and my current doc doesn't generally use them because they don't give the whole picture of what is going on in bones, he said. He did order a CTX for me in my complicated situation.

I discussed cortical porosity with McCormick but doc told me Tymlos does not affect it the way Forteo does.

I think the big difference is the way they look at my CTX results from the past and how the CTX might relate to timing of Reclast after Evenity. Doc says my normal post-menopausal CTX may be on the low side, and McCormick thinks it should go up some before I take Reclast. Doc says Reclast is fine with my CTX and should happen soon after Evenity, but McCormick thought I should wait. I am seeing another endo next week who does use CTX and P1NP and see what she thinks.

@sarahfloranne issues with Prolia include risks you mentioned when getting off, and also it may affect the effectiveness of bone building drugs like Tymlos, Forteo and Evenity in the future. Dr. ben Leder, in his video on You Tube on Combinations and Sequencing, does say that combining Prolia and Forteo (or Tymlos, presumably) is potent.

If your bones aren't too bad (over -3.0) you could consider "whole body" approaches. It might be hard to get insurance for bone builders. It is known to be better to do bone builders before anti-resorptives like Prolia or Fosamax.

Once you start Prolia, you are basically committing to Reclast or Fosamax at some point in order to get off Prolia, and I have read that in some cases even then there are problems. If you are older, you might make sense to just stay on Prolia but honestly I think that would be true for 85+!

I had a trip/fall several years ago resulting in having my right shoulder and elbow replaced. I also injured my left wrist & had a metal plate inserted to stabilize. As a result, my right forearm is a -4.5. My lumbar spine is-0.6; right femoral neck is-2.3; right hip is -1.5. My biggest concern is my right forearm which they say is like Swiss cheese & very fragile.
I have not been taking calcium/vitamin D. My left hip was replaced years ago. I am 82 years old & have a lot of problems because I was on steroids & methotrexate for 13 years. I had poly myalgia rheumatica.
Do you think this is my best option or should I try the bone builders first?

Most of your scores are pretty good. Lumbar spine is excellent, hip is good, the femoral neck tends to be worse but is still not osteoporosis. Gosh I would hate to take a med just to address my right forearm but yours is an unusual situation.

How did the replacement of shoulder and elbow affect the forearm?

At 82 you might be able to do Prolia and just stay on it. My friend is the same age and is doing that. Or you could do a bone builder. But I am curious what doctors say about addressing that one body area when everything else is pretty good. It makes me think of wrapping that forearm in bubble wrap!!!! Let us know what your doctor(s) say and maybe a second opinion would help too.

Thank you for your suggestions. I may get another opinion & also see about trying a bone builder first. I am on 17 medications now for all my other problems. I just hate the thought of adding another one.

@windyshores- Wow, you’re hooked up with at least 3 people providing info. How did you manage that, and how is it so timely - as you’re going to get that 3rd recommendation next week????

So you had your CTX and P1NP blood tests while taking evenity? I last had mine before I started evenity and was told that evenity affects the results of CTX especially..

@daph I did one Evenity a month ago. I want to see how it is working because I am having side effects. I also wanted these tests done as baseline in case I switch to Reclast. I did Tymlos for two years, up to Dec. 2023.

In the first month P1NP skyrockets on Evenity but effect on CTX might be later, I believe.

If my CTX is too low I am concerned I might expose my kidneys to damage (I have kidney disease) with no benefit on bones. One doc says wait, one doc says Reclast asap, and seeing a third doc this week.

@ans I was so lucky with cancellations. I also got in to an allergist within 24 hours. I find if you call around 10 am there are sometimes cancellations and even if you are further down on the waiting list, they will give the appt. to you since you are on the phone 🙂 And...my main endo called me unexpectedly.

I keep changing my mind depending on the wax and wane of symptoms! I hate being 50/50% on decisions. Typical Gemini plight. Noone is going to rescue me on this decision except me. But I am getting all the info and opinions I can in a short pan of time. I have to decide by Thursday.

@windyshores- Thanks and GOOD LUCK! Will be waiting to hear . I, too, am at a critical place in my plan, though not as critical as yours. Picking up my CTX and P1NP lab results today , have a time to speak with McCormick on Monday , and then I think I'm off to the races with Forteo after the authorization and insurance issues get ironed out.