Thank you for your very detailed reply!

Based on your aunt's TScores, I am astonished that her doctor put her on Prolia which should rightly only be used for those at high risk of fractures and where other meds prove ineffective. It is probably fortunate that the doctor was not able to continue prescribing Prolia because there's no sure way of mitigating the rebound effect once you have been on Prolia for 4, 5 or more years

Thanks for the youtube link and the very useful pdf. I have seen another interview where Dr McCormick expressed his view that, for 3 or more Prolia shots, Alendronate is not potent enough to mitigate rebound and you would need to use Reclast (zoledronic acid). But i have read other sources that say Alendronate is ok for up to around 2-2.5 years of Prolia (see link below):

Also, the following is a youtube video where the doctor recommends the use of Alendronate for someone who has been on Prolia for 2 years:

It's likely that your aunt's active lifestyle precluded any rebound fractures. Also, it's been speculated that treatment with bisphosphonates prior to Prolia may help in mitigating the rebound effect

Did you do any BTM labs before starting treatment to use as baseline reference? You did your zol infusion in Nov 21 and your CTX in Nov 22 is 179. But a year later in Dec 23, your CTX is 130 (?). I would have expected your CTX to go up as you were not on any other osteo med after your zol infusion more than 2 years ago

Edit: saw from your earlier posts that you did not have any baseline BTMs done and your low CTX could be due to your hypothyroidism. I agree with your assessment that anti-resorptives are probably not appropriate for treating your bones. Are you currently considering anabolics? Personally, i am cautious about any osteo med and i want to give drug-free treatment a chance