Does anyone know if I can get dental work done before starting reclast

Evenity has the lowest reported incidents of osteonecrosis. Evenity stays in your system for about 64 days after the last dose.
Forteo is used to promote healing in the jaw. And is used as treatment for osteonecrosis. I would want a prescription for Forteo during this time, and following. It is not commonly used following Evenity. I think that is because they didn't know that the last nine months of Evenity are actually antiresorptive.
Because the last nine are antiresorptive, i wouldn't want to follow Evenity with another antiresorptive especially Prolia (because I consider it a dangerous drug) but even reclast because there isn't sense in following the antiresorptive with an antiresorptive, and because anabolics build better bone.
I would start Forteo or Tymlos now and wait the 64 days for the dental work.
I write this with confidence only because I know that alternative ideas will follow.

I was on Tymlos and followed with Reclast. Before starting Reclast my endo required me to consult with my dentist.

My dentist said he would be OK as long as the jaw was not affected. The problem would be that it took about 6 months for the bone to fully heal. If something like that came up after I was on Reclast he would probably send me to a bone surgeon who could evaluate my
status at the time.

Although it does not surprise me that dentists are reluctant to discuss Reclast vs Prolia. Hopefully your dentist can answer your specific question and whether 2 months is sufficient recovery time.

Hi @gentlly
thanks for the advice. My key problem is that I’ve used almost a month up trying to find the right surgeon ( dental) and my two endocrinologists that I consult with both say I have to get going on reclast or prolia WITHIN 2 months…I stopped evenity ( finished 12 mos. On May 20th..so have until July 20 they say to do my surgery without any med…but get on reclast before 2 months are over…it’s pretty tight…have you heard of anyone getting Forteo right after evenity and right after my possible dental surgury and partials installed? Will Forteo hold the bone growth I got? I asked the doc by email if I can start Gortro or any one that will help keep the bone growth for even 1-2-3 months before starting reclast….is this a sane request. ? I don’t think she will like it….i can’t find facts to back up what I’m worried about…help…

sando, I haven't heard of anyone taking Forteo after Evenity. And can't find anyone advising that sequence. Looking at the loss charts and the mechanisms of action, Forteo after Evenity seems most sensible to me.
Your surgeon may prescribe Forteo during your treatment. Which would protect your jaw and help secure your partials.
Your request is sane and she probably won't like it. You might present it in terms of advancing jaw healing during surgery. You may have better luck with the surgeon.
While it is important to follow up Evenity with something, it seems mistaken to follow an antiresporptive with an antiresorptive, even granting that they work in different ways.
looking at charts of bone loss after Evenity, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6877701/ figure 3 column 1 indicates the percentge of loss in months if taking nothing after Eventiy https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=6877701_198_2019_5146_Fig3_HTML.jpg
There were 46 women who took Forteo after Evenity, but those results weren't included in the study.
I consider your best bet to ask for several months of Forteo during surgery. I would ask both the unhappy physician and the surgeon. Then proceed with the surgery at a comfortable pace with or without Forteo.
In this study the women who took nothing for a year after Evenity and then had a second dose of Evenity had better results than those following with Prolia. Curiously.
I'm afraid this is tooo much information. And not so very helpful or supportive of your quest. But I also think you 'll be safe during treatment. I'd love to see your bone markers during this time. Maybe you should request them prior and then monthly during treatment to acertain whether you need to pause treatment. And so I could look at them. Bless your quest with luck.

Hi @gently how did those 46 women who took FORTEO after evenity fare, bmd and btm wise? Are you able to see the results?

The trial wasn't concerned with the Evenity/Forteo. There is a graph of Evenity/placebo which might help determine how soon a person could wait before Recalst. I haven't heard of anyone using a Evenity/Forteo sequence. There must be knowlege that eludes my reasoning. But maybe since it was thougtht that Evenity was 12 month anabolic, it wouldn't be advantageous to follow with an anabolic. https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=6877701_198_2019_5146_Fig3_HTML.jpg
Any ideas?
And where've you been?

@gently it’s interesting to see a continued increase of bmd during 2 years of romosozumab treatment, noting the brief surge of P1NP for ~3mo and a suppressed CTX for almost the entire 2years. When we look at the placebo arm of fig3, the jump of CTX at cessation of romosozumab is asking a taming agent or bone loss will ensue, my take. With a prospect of an oral surgery here, maybe a short course of bp such as fosamax or even risedronate for 3 mo then followed by forteo may work? Oral surgery to be done after starting of forteo?

I’ve been sleeping with a lopsided schedule after coming back from a trip to far east. Reconnect here

@sando is your oral surgery urgent? If it’s an extensive work involving bone healing, getting it done with evenity +prolia at background doesn’t sound good, not with Reclast either. Will you be having enough time to discuss with your endo with alternatives such as a short course of a bisphosphonate (fosamax or risedronate) then transition to forteo? Forteo is a tested op med for extensive oral work. It is used for patients who have jaw necrosis also.

mayblin, the thing being different is that romosozumab suppresses CTX by disabling the production of osteocytes and consequently the entire remodeling system. P1NP jumps, but not fast enought to catch
the osteoclasts. It stands to reason that as remodeling is halted just at the trigger for osteoclast formation.
All roads lead to Forteo.
Sando's dilemma is needing the oral surgery between Evenity and Reclast. With the endo looking at the 64 limit of Evenity in the system. Insistent enough to indicate that approval for a next application of Evenity in some future would be compromised. The duration of use of these antiresorptives would make me avoid any of them until after the oral surgery is completed. Worse is that there are two endocrinologists. Oral surgery July 20.
The risk of ONJ after Evenity is lower than the risk with bisphosphonates. Forteo can only help both with the surgery and halting the damaging proliferation of osteoclasts. The oral surgeon is more likely to prescribe a short course than the unhappy endocrinologist. And Sando's bone markers would be a guide and a tiny window into Forteo after Evenity. But I would like you to throw your weight in the opposite direction.
These are dental implants.

After rereading the original and subsequent posts, it seems sando finished evenity on 5/20, endo(s) gave 7/20 as last day to start reclast or prolia as antiresorptive. Sando is trying to get oral surgery done sometime during this 2 med-free months. Oral work includes pulling teeth and something less involved, i.e., not an implant. Correct me @sando if I didn't fully understand the situation here.

In any case, I agree with @gently not going with prolia, a problematic drug. If dental work doesn't involve implants or bone related healing too much, reclast might be okay. It may delay any bone related healing somewhat. Reading from various sources, it's surprising to know that necrosis of jaw occurs very rarely, with most cases involving large dosing in chemo patients. The problem with reclast here is the long length of its antiresorptive effect - something to keep in mind just in case your dental needs turn out to be more extensive than you had previously thought.

Taking FORTEO during extensive dental work involving bone healing is ideal. Since sequential usage of FORTEO after evenity is not well studied yet, introducing FORTEO during the short window after evenity as @gently suggested might be very tricky. The question is whether or not the early anabolic effect of FORTEO will overpower the suppressed osteocytes production/remodeling system brought on by evenity, in a timely fashion. IF, sando's dental work is not urgent, then use of a short-term bisphosphonate will allow "lock in" bone gained with evenity, while allow ample time for coordination of scheduling, planning with docs as well as possible insurance approval process of FORTEO.

I’ve read that you should have any l needed dental work (especially extractions) done before you go on any of the osteoporosis drugs that can possibly cause osteonecrosis of the jaw bones. Apparently if you have extensive dental work done while taking these meds, there is a risk of not healing properly.