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← Return to Prolia black box warning?
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I just want to remind everyone that Prolia is an incredible and very unique drug to help people with osteoporosis. There is no other drug on the market that you can take for long periods of 10+ years and continue to see improvement in BMD in both the spine and the hip. And as far as transitioning off Prolia, it's not much different than any of the osteoanabolic drugs like Evenity, Tymlos or Forteo. You just need to be aware of the rebound you will see after stopping and account for it in your treatment. If you are on Prolia for 2.5 years or less, you can expect to hold BMD levels by switching immediately over to Fosamax or ReClast. If you are on Prolia 3+ years, you should plan on losing about 5% BMD (1/2 of a T-score), and that is also with an immediate transition to Fosamax or ReClast. This information is from a Dr. Serge Ferrari presented in September 2023 at the 9th Central European Congress of Osteoporosis.
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I get that Prolia is a complicated topic as it does have strong benefits but it has a risk that I'm not aware of any other Osteoporosis med having. That is a rebound effect that means if you stop Prolia you may not only lose the bone density you gained but you may experience multiple fractures in a short period of time. I've seen people posting about having up to 10-12 fractures by stopping Prolia and not knowing the possible consequences.
That is not what happens with Evenity, Tymlos, or Forteo. So far as reported people just lose the bone they gained if they don't follow the anabolic with an anti-resorptive. They do not report multiple fractures.
I don't use the word rebound for the anabolic meds. I like this definition for medical rebound effect "Stopping a medication can cause withdrawal (discontinuation) symptoms, the return of the original illness, and rebound. The latter means that the disease will return stronger, faster, or with greater likelihood than if it had not been treated with medication".
So the "rebound" portion of the definition is where the condition gets worse. 1-12 fractures from stopping Prolia without immediately starting another med is definitely worse. Losing what you had gained with an anabolic is not what I consider a rebound.
Keith McCormack offers a possibly safe effective brief use of Prolia immediately followed by Reclast. I'm still thinking about that one.