High anxiety regarding Reclast or Prolia decison for OP meds

Hi @255anny if I understood your sequence correctly: forteo-->evenity x1yr-->proposed prolia x 1year--> proposed evenity again, this article by Dr. McClung might be worth reading as a starting point:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8260819/#jbm410512-bib-0014
Please look at Fig 1, part A for "phase 2 study and extension". Your sequence resembles line 5, which was evenity x2yr -->prolia x1yr --> evenity x1yr in that study. Total of 52 patients were involved in that particular arm. Then follow what the authors had referenced, #14, #17 and #18 articles will give you a total picture of what happened with bmds as well as btms for that sequence in the study. Happy reading and best luck!

@mayblin
@windyshores
That is very interesting. Thank you for the link to that study. I do recognize 2 of the author's names 🙂 So, the treatment sequence my Dr is suggesting is not exactly new or unheard of. My concerns would be, 1). Would the second course of Evenity be enough to hold off the rebounding effect from the Prolia? 2) The very small number of participants in this study.
3) The fact that the increases in BMD were smaller than the initial increases that one gets from the first course of Evenity. 4). After the 2nd course of Evenity, would that be followed by Zolendronate?
I feel somewhat better about this sequence, but doing this kinda makes me feel like I'm doing my own drug study! I wish there was more written about this sequence. The safety aspect appeared ok in the study, so that might be of no high concern. My biggest concern is the rebounding from Prolia. But since the Prolia would be 1 year (2 doses) is the rebounding a risk after just 2 doses? I have read that it can happen after just one dose. Obviously, I have to make a decision. The lack of information about the sequence has me concerned. Of course, I could talk to my Dr but I'd like to be better informed before I do that, so that means I will dig further. Oh gosh, more sleepless nights.
@windyshores and @mayblin - thank you both sooo much.

No gains with Forteo. I had no side effects. The only negative I have with Forteo is that it has to be kept cool. That made it difficult to travel, but I always found a way.

@mayblin
@windyshores
That is very interesting. Thank you for the link to that study. I do recognize 2 of the author's names 🙂 So, the treatment sequence my Dr is suggesting is not exactly new or unheard of. My concerns would be, 1). Would the second course of Evenity be enough to hold off the rebounding effect from the Prolia? 2) The very small number of participants in this study.
3) The fact that the increases in BMD were smaller than the initial increases that one gets from the first course of Evenity. 4). After the 2nd course of Evenity, would that be followed by Zolendronate?
I feel somewhat better about this sequence, but doing this kinda makes me feel like I'm doing my own drug study! I wish there was more written about this sequence. The safety aspect appeared ok in the study, so that might be of no high concern. My biggest concern is the rebounding from Prolia. But since the Prolia would be 1 year (2 doses) is the rebounding a risk after just 2 doses? I have read that it can happen after just one dose. Obviously, I have to make a decision. The lack of information about the sequence has me concerned. Of course, I could talk to my Dr but I'd like to be better informed before I do that, so that means I will dig further. Oh gosh, more sleepless nights.
@windyshores and @mayblin - thank you both sooo much.

@255anny, you are in a tough position!!! 2 separate sequences to think of. Evenity to a relay then a relay drug back to evenity. There might not be studies available with good number of subjects to show powerful statistical significance since evenity is relatively new. If it is just evenity--> prolia or reclast to be considered, then it'd be a lot easier. Obviously your endo has another round of evenity in mind for you after the relay drug. Hence not only you need to pick a relay drug that you are comfortable with, you need also think about which sequence (prolia -->evenity, or reclast --> evenity) will turn out better, on top of the worrying about potential prolia rebound effect. Toooo much! There are couple publications I read re evenity after 1-2 shots of prolia. It seems bmd increases were dampened but there were increase. There was a paper by Japanese researchers for evenity after reclast but results weren't clearly tabulated since there were other bps involved.

@255anny, you are in a tough position!!! 2 separate sequences to think of. Evenity to a relay then a relay drug back to evenity. There might not be studies available with good number of subjects to show powerful statistical significance since evenity is relatively new. If it is just evenity--> prolia or reclast to be considered, then it'd be a lot easier. Obviously your endo has another round of evenity in mind for you after the relay drug. Hence not only you need to pick a relay drug that you are comfortable with, you need also think about which sequence (prolia -->evenity, or reclast --> evenity) will turn out better, on top of the worrying about potential prolia rebound effect. Toooo much! There are couple publications I read re evenity after 1-2 shots of prolia. It seems bmd increases were dampened but there were increase. There was a paper by Japanese researchers for evenity after reclast but results weren't clearly tabulated since there were other bps involved.

Are we allowed more Evenity after a year? That's another reason I stopped at 4 months- so I can have it in the future. Maybe that was not necessary.

@255anny did your dexa report come with TBS? If so, even you didn't have bmd% increase with Forteo, you could compare TBS scores before and after to get a sense whether there were improvements in bones' micro architecture. I read that if the dexa machine that you used didn't have the function but later installed the software, you can ask your old data to be inputted in and TBS score be calculated.