Prolia/Forteo combination therapy?

Hi, I hope everyone is coping at worst and really well at best. I'm a bit confused and worried about recent treatment I've been put on for my extremely severe osteoporosis. I hope someone may be able to help. I was put on Forteo in 2016-2018, and fortunately tolerated it well. Then I received 2 zolendronic acid infusions.
I then moved home and treatment team. In 2023 a consultant I saw told me that I absolutely needed to be on Prolia/denosumab. So I had 2 injections over a year. In my follow up annual appointment I saw a different consultant of thr same team and he said I should not have been put on Prolia because I'd had forteo and it wouldn't work/be any good.
He then said he felt putting me on Forteo for another 12 maths 2024-2025 was the best chance to help me.
Unexpectedly, I have been experiencing bad side effects but I am determined to continue because I'm so desperate for my bone density to improve as it's still -3.4 (?).
I was confused because tge previous consultant insisted that prolia is 'Gold standard' and is the absolute best option.
So to be told different information by a consultant of the same team is concerning.
I've since looked into having prolia after or in combo with forteo and it seems there's a lot of evidence that the combination is actually really effective. Now I'm not sure who is right. What to do or whether to ask if, while I'm on forteo could I also continue prolia? Or is that greedy? I don't want to ask for too much or seem entitled. Thank you for listening and any advice . Take care, Goose x

Hi, I hope everyone is coping at worst and really well at best. I'm a bit confused and worried about recent treatment I've been put on for my extremely severe osteoporosis. I hope someone may be able to help. I was put on Forteo in 2016-2018, and fortunately tolerated it well. Then I received 2 zolendronic acid infusions.
I then moved home and treatment team. In 2023 a consultant I saw told me that I absolutely needed to be on Prolia/denosumab. So I had 2 injections over a year. In my follow up annual appointment I saw a different consultant of thr same team and he said I should not have been put on Prolia because I'd had forteo and it wouldn't work/be any good.
He then said he felt putting me on Forteo for another 12 maths 2024-2025 was the best chance to help me.
Unexpectedly, I have been experiencing bad side effects but I am determined to continue because I'm so desperate for my bone density to improve as it's still -3.4 (?).
I was confused because tge previous consultant insisted that prolia is 'Gold standard' and is the absolute best option.
So to be told different information by a consultant of the same team is concerning.
I've since looked into having prolia after or in combo with forteo and it seems there's a lot of evidence that the combination is actually really effective. Now I'm not sure who is right. What to do or whether to ask if, while I'm on forteo could I also continue prolia? Or is that greedy? I don't want to ask for too much or seem entitled. Thank you for listening and any advice . Take care, Goose x

How frustrating to be pulled in multiple directions.

Though I personally am not a fan of Prolia, there is research showing that Prolia either in combination with Forteo, or after Forteo is the most effective treatment. I'm not sure that doing Forteo after having Prolia works. Maybe someone else knows.

Here's the link to a YouTube presentation by Dr. Ben Leder on combination and sequential treatment. You may find it helpful.

Thank you so much @hopefullibrarian ! I really am grateful for your insights and just being supportive and empathetic. I'll watch the video and also see if it's possible to get an appointment with one of the consultants I saw to ask more questions. Fingers crossed.
I imagine it is rarely a straight science and people respond differently. Plus age and cause etc may play a part in their choices? I'm 44yrs, diagnosed at 18yrs. So I've had near 20 fractures and although I'm very restricted in what I can do now, I am so grateful to be receiving treatment and to have not had worse. I am fearful of the future and what may come as things deteriorate more. But I imagine others feels very similarly and I know there are people suffering a lot more than me, which is awful to think about.
Sending support and hope to all x

Hello @goosegirl and welcome to Mayo Connect. I can understand your concern about the medication dilemma you are experiencing now. Being given two different opinions within the same medical practice must be confusing.

You mentioned that you are experiencing bad side effects with your current treatment. Could you share a little about what those side effects are? I'm also wondering if you have discussed these side effects with your medical team. If not, this is an important first step. While this might be a great medication, the side effects should be mentioned to your doctor. You are definitely entitled to understand what is going on as you treat this bone loss.

When are you scheduled to have your next Dexa Scan to check on the effectiveness of the medication on your bone density improvement?

Thank you very much @hopeful33250 . I really appreciate your kindness and the time you took to read and reply to my post.
I reached out to my team a few weeks ago when the side effects became so bad I dreaded waking up because i was in so much pain (particularly waist down, and in my lower back and even more limited in my daily life), but also extremely low in my mood & migraines. I realised I couldn't live like that. It may have been the increased pain causing hopelessness and low mood, or another side effect. It was hard to tell. The nurse was really supportive and spoke to my consultant. She told me to take a 2 day break and I was shocked how dramatically better I felt within 24hrs of not injecting.
However, the consultant urged me to restart after the 2 days and persist because my bones needed the treatment and the sideffects often reduce after a while.
I've really tried and am coping better now. The migraines have stopped and although the pain is definitely high again, I find doing the injection early evening means my midday the following day the pain eases enough for me to focus on others things and I can even get out and about a little more now.
I really am so scared of stopping treatment but I know if my mental health deteriorates too much again I do need to reconsider continuing because of my mental health history/existing conditions.
I will talk to the nurse and ask if it's possible to have an appointment to discuss prolia in sync with teriparatide. Plus discuss other options if things reach the point I cannot continue the treatment due to side effects.
Thank you very much. Sending love and hope x

Given your history, doing the combination therapy does not sound the least bit "greedy." In fact, if your insurance is willing to cover it, you may be the perfect candidate. We're fortunate to have access to anabolic treatments these days.
Best of luck whatever treatment you decide to do.