Prolia has a serious rebound when stopped, with decrease in bone density and increase in fracture risk. People then go on a bisphosphonate, preferably Reclast due to its potency vs Fosamax. Lately experts like Keith McCormick have been advising Prolia for 1-3 shots so that Fosamax (or Reclast) can more strongly counter the rebound. McCormick also has some complicated instructions for that transition, using bone marker testing to determine the best timing of a bisphosphonate after Prolia.

People can do Prolia longer than bisphosphonates (bisphosphonates are used for 3-5 years generally), but then there is rebound when stopping Prolia....apparently according to McCormick's book "Great Bones," possibly leaving you worse off then when you started. My doctors rarely use Prolia.

Does your rheumatologist think you would stay on Prolia long term? Has that doctor discussed what to do after Prolia? We all need long term plans.

If your bone density is not too bad, an anti-resorptive might be appropriate. Insurance likes us to start with them because they are cheaper than anabolics!

If your bone density is poor, the advice from McCormick, videos on YouTube (see Ben Leder's "Combinations and Sequencing..") and my doctors is to do an anabolic first: Tymlos and Forteo are anabolics, and Evenity is both anabolic (first 6 months) and anti-resorptive.

I hope you can find a doctor you trust! I use an endocrinologist who mainly does osteoporosis.