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

Hey@gently…I’ve been overwhelmed but wanted to update you, as I remain scared…despite telling fear to go away! I got the Forteo delivered to me…and I have 2 docs saying it will ruin your health ( bone cancer) and one saying ok…with no citation as to why it’s ok. I’m
concerned as I’m no dr and it ends up as me making the final decision on the basis that I’m guessing Myclast and Prolia are dangerous…I’m uneasy. It’s now over 60 days since I last took evenity…please summarize again what you know and who I might call…I’m in shreds of worry…but have to act now…fear coaches has taken over…please help..Sandy

Hey@gently…I’ve been overwhelmed but wanted to update you, as I remain scared…despite telling fear to go away! I got the Forteo delivered to me…and I have 2 docs saying it will ruin your health ( bone cancer) and one saying ok…with no citation as to why it’s ok. I’m
concerned as I’m no dr and it ends up as me making the final decision on the basis that I’m guessing Myclast and Prolia are dangerous…I’m uneasy. It’s now over 60 days since I last took evenity…please summarize again what you know and who I might call…I’m in shreds of worry…but have to act now…fear coaches has taken over…please help..Sandy

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.

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.

I just came across this forum and have a very similar question, experience. I have been on Prolia for 6 years and was put on it without consulting me about potential dental issues. After a year or two I discovered that I would have problems having dental work. At the time I already had about 15 crowns and a bridge and three root canals so I'm surprised I was even prescribed Prolia. Now I'm at a point where my parathyroid is starting to the elevated, as well as my blood calcium. I have only been seeing a bone health specialist, nurse practitioner, for 6 years that I've been on Prolia. I recently had a failed bridge and had to have a bone graft which took just fine. I was told I could have dental work, two implants installed, approximately 4 months after my last Prolia injection, which I did. After 2 weeks the bone started to erode in my jawline where the implant was located so my oral surgeon removed both implants and I am in the process of healing now. Due to my elevated parathyroid and my strong feeling that I should no longer be on prolia, we are searching for answers to what I can transition to an off from Prolia. Seem to be caught in a very big catch 22 situation, with regards to what medication I can take into whether I can ever have my dental work completed. I have now made an appointment to see an endocrinologist as well as a rheumatologist, to explore what would be the best course of action. I am postmenopausal and had a hysterectomy at age 35 so I don't know if some of the oral medications will work for me? I was told reclast is not an option for me because of the potential damage to my jaw. My bone health specialist is recommending Evista but I don't like the side effects that I'm reading about. Does anyone have any input as to what might work in my situation? Something that I can transition to so that I can get off of Prolia, without damaging my jaw any further? I've been told I cannot just call turkey off Prolia and also that I may never be able to have dental work again, meaning I will be missing three teeth on the lower right side of my mouth? I am very depressed about my lack of options at this point. I am bound and determined to not continue Prolia any longer I think there are other side effects of experiencing due to the length of time I've been on this drug.

As you know, after many years' treatment of prolia, AFF or ONJ could occur although incidences are very rare. You don't have either but if you are planning major dental work while dealing prolia withdrawal at the same time, you most certainly need a bisphosphonate to deal with the potential rebound effect from prolia withdrawal (to prevent potential VCFs); also likely you'd need either tymlos or forteo to help building/healing of jaw bones from oral graphs.

Here is a previous thread in which many members discussed a similar case of prolia withdrawal with the presence of AFF:
https://connect.mayoclinic.org/discussion/the-doctors-reply-after-prolia-aff-and-now-recommends-forteo/
Wish you the best!

Thank you very much for your input and your prompt response. I probably didn't clarify in my original post that my dental implants failed and the oral surgeon indicated that I had the beginnings of ONJ. It is been about 3 weeks and my gums are healing, but the back tooth adjacent to the missing teeth and the gum area that was affected is slightly sore so we are watching it. My bone health specialist indicated because of potential onj risks, I could not have reclast which is what I would prefer, as the Envista option sounds like it has potentially dangerous side effects. If that is my only option, I guess I will have to go that route and hope for the best.

Hi @jheieck I'm sorry to hear that you are in this dilemma. Cessation of prolia after 6yr treatment could be a quite endeavor on its own which might take 1-2 years. Raloxifene (Evista) is a mild to moderate antiresorptive compared to a strong one like Reclast. To use raloxifene for prolia cessation, your endo may use bone turnover marker CTX to monitor the progress. If you have elevated parathyroid hormone, my mention of potential using either Tymlos or Forteo to aid bone healing in last comment may not be a valid one. It's good that both your bone specialist/endo and oral surgeon are taking your current situation seriously. Hope everything works out for you!