Hey Formisc,

I believe your transition from Prolia to alendronate had perfect timing and will hopefully allow you to avoid any type of rebound. Might be a good idea to check your calcium in the next 30-60 days just to be sure CTX stay low but you're probably good. Many people that transition like you did after just 18 months will continue to gain bone mass on alendronate after Prolia. You might also have a low CTX baseline, which again, helps with the transition. I would not worry about the low CTX markers. Low is good and it will continue to be suppressed on alendronate. For reference, my CTX after one month on Prolia was 37pg/mL. It will be higher by month 6 before my next shot.

Not sure what to tell you on dental surgery other than tell your surgeon that you are on alendronate so they can get the job done quickly to minimize risk. Exposed bone seems to be what you want to avoid.

So the low calcium needs to be addressed. I to saw my calcium drop when I started Prolia and have bumped up my intake. I have hypercalciuria as well which means I have to take even more than the average just to have a chance at building bone. Low calcium can cause all kinds of side effects so you need to make sure you're getting enough in your diet + supplements. Prolia and alendronate will make it more difficult for your body to borrow calcium from your bone bank (so to speak). You REALLY want to get close to the 1200mg/day range to ensure you have enough calcium to support your bodies set point as well as to have enough for your bones to build. You can't build bone without calcium.

25(OH)D looks perfect. To low or too high is not good for bones. I'm a bit surprised your PTH is only at 3.5 pmol/L (33pg/mL). PTH will typically go high when serum calcium is low. I would have expected numbers closer to 60-70pg/mL. I can't explain that one. Maybe my conversion is off.

Albumin looks great too. No calcium correction required.

My two cents.