Hi Formisc,

I understand your viewpoint with so much data being thrown around. I was in your camp for some time before I decided to get the latest information from the doctors that are training doctors at the major osteoporosis conventions. The grand daddy of these events is the World Congress of Osteoporosis. This year is hosted in London. While I will not be flying out there, I’m hoping to get recordings of the presentations like I did last year.

To ease your mind a bit about fractures after Prolia, here is a link to the study that I describe in my Prolia presentation https://asbmr.onlinelibrary.wiley.com/doi/full/10.1002/jbmr.4335 . Dr. Serge Ferrari presented slides from this study at the 9th Central European Congress of Osteoporosis. It shows how breaks are very prevalent for patients without bisphosphonate treatment after Prolia, but it also shows how infrequent breaks were when bisphosphonates are used. See figure 5. I think you are going to be just fine on alendronate.

Your hip will likely still be in the osteoporosis range even after a year of Alendronate. Perhaps after a year, you could switch to one of the osteoanabolics to build some structure with the BMD then switch back to alendronate.

Good luck!