High anxiety regarding Reclast or Prolia decison for OP meds

@25anny how long you would take Reclast after Evenity depends on your DEXA and your bone markers. My docs expect me to do it for three years but I doubt I will. The limit is 5 years, not sure if that is for a lifetime or one course. Most people are able to take a drug holiday. Some docs do it every 2 years.

There is no data, according to my doctors, on Evenity after Forteo or Tymlos, let alone on the other way around. I was originally told, I think in a masterclass on osteoporosis, that you could do Tymlos or Forteo first but not Evenity, possibly because Evenity "turbocharges" growth (I remember that word being used) so there is less for the other meds to do. But Evenity came out in 2019, that was early 2021, so I don't know what has come out since. My doctors are very "evidence-based" and are waiting for studies so Reclast is all they discuss right now. I am going to bring up doing more anabolics.

I don't think there are any definite answers right now. It's helpful that we all research (and share it) but in practice the choice right now are limited: seems to be Prolia or Reclast after Evenity and if Prolia is done, many people are doing one year and then doing Reclast. Even that latter strategy is relatively new, at least for me. I am doing lower dose Reclast more often so am in your same position of wondering what to do next.

From one evenity study I read, on average, bmd increased a little over 4% during 0-3mo, closer to 4% during 4-6mo, then roughly 3-4% during months 7-12. If therapy continues, the second year had another few percentage increase in bmd so not very effective. Like you noted, efficacy in bone building is greatest during first few months.

@25anny how long you would take Reclast after Evenity depends on your DEXA and your bone markers. My docs expect me to do it for three years but I doubt I will. The limit is 5 years, not sure if that is for a lifetime or one course. Most people are able to take a drug holiday. Some docs do it every 2 years.

There is no data, according to my doctors, on Evenity after Forteo or Tymlos, let alone on the other way around. I was originally told, I think in a masterclass on osteoporosis, that you could do Tymlos or Forteo first but not Evenity, possibly because Evenity "turbocharges" growth (I remember that word being used) so there is less for the other meds to do. But Evenity came out in 2019, that was early 2021, so I don't know what has come out since. My doctors are very "evidence-based" and are waiting for studies so Reclast is all they discuss right now. I am going to bring up doing more anabolics.

I don't think there are any definite answers right now. It's helpful that we all research (and share it) but in practice the choice right now are limited: seems to be Prolia or Reclast after Evenity and if Prolia is done, many people are doing one year and then doing Reclast. Even that latter strategy is relatively new, at least for me. I am doing lower dose Reclast more often so am in your same position of wondering what to do next.

@windyshores I really don't get the strategy of doing Prolia for one year following an anabolic and then doing Reclast. There is some modest advantage in increasing bone density with those 2 Prolia shots over the Reclast shot but to go for a modest bump in density when doing so opens up the possibility of rapid bone loss and multiple fracturing. Seems like a lot of risk and worry (at least if you know what you are doing you would know there is a risk). for again a modest potential gain in density. Both Prolia and Reclast give you an increase in density but with different risk "profiles". Sorry I'm not providing numbers here but I would have to spend too much time searching for that info. I'm in the camp of "No on Prolia" unless I'm convinced I'm in my last years of life and won't have to stop taking it.

It's so confusing!
At this point in my decision journey, my research points in these directions. But surely, there are other options and sequencing protocols. But maybe not.

1) Evenity>>Prolia 1 yr. >>Reclast
2) Evenity>>Prolia 1 yr. >>Evenity. Dr's prescribed sequence
3) Evenity >>Reclast
Each option has pros and cons. I'd like to avoid the Prolia and the rebound effect after stopping, even after 1 year. I'm not convinced the dual actions of Evenity has enough ummp (!) to blunt the rebounding of Prolia. I understand the proposed jump in BMD we should get from the Prolia, but not everyone responds with great gains. So why take it?
Realizing my spine is _4.7, after Evenity, is Reclast not what I need?
Reclast adverse side effect bother me. Just how bad is it!

255anny,
if I were in your situation I would take Tymlos. It is an anabolic very like Forteo, but thought to be more effective than Forteo in the spine.
windyshoes' interesting speculation that perhaps the increase from a new medication may supercede whatever loss there might be with the relay drug. ( Windyshores is an experienced Tymlos user and offers invaluable advice about taking the medication. )
I applaud your fears about the pharmaceuticals osteoporosis patients are sometimes pressured to take.
If I encountered resistance to efforts to obtain Tymlos, I would happily take a second round of Forteo. Oh, said to be "as robust as the first."
I would definitely want P1NP and CTX before and two months in with Tymlos to ascertain that it is working.
I'm not addressing any "need" for advice to take Prolia/Evenity/Prolia, but listen to yourself.
Bless your choice.
gently

@mayblin I made myself crazy wondering if I should stop Evenity after 3 months or 4 month or 6 months and so on as the bone building supposedly decreases. I did not stop, I've had 10 so far. I think the question is does it decrease so much that there's no point in continuing to take it. I even saw in another forum that a nurse had advised someone to stop as there was no point in continuing.
I think we have all gotten confused over this. Assuming your numbers are correct (and I saw that study to) the rate of increase in bone density after 6 months is about a half of what it was in the first six months. But it's still a nice gain in months 7-12. 3-4% for 6 months means that the yearly rate would be 6-8% which is getting close to Forteo treatment yearly increases isn't it? Nothing to sneeze at or dismiss because of the statement that most bone building occurs in the first several months.

Maybe it's the P1NP that spikes quickly and then returns to normal that has everyone thinking it can't be building bone because the P1NP is no longer elevated. Maybe that means that it's functioning as an anti-resorptive and not building new bone but maybe we just don't understand it well enough. Maybe after that P1NP spike it keeps building bone despite the P1NP dropping back down quickly. Seems to me the important point is that the increase in bone density continues quite nicely. I go with the DXA scores on this one. The 13% gains they got for one year in two large studies and the reduced fracture rates. I'm getting a DXA this coming week. Fingers crossed.

@mayblin I made myself crazy wondering if I should stop Evenity after 3 months or 4 month or 6 months and so on as the bone building supposedly decreases. I did not stop, I've had 10 so far. I think the question is does it decrease so much that there's no point in continuing to take it. I even saw in another forum that a nurse had advised someone to stop as there was no point in continuing.
I think we have all gotten confused over this. Assuming your numbers are correct (and I saw that study to) the rate of increase in bone density after 6 months is about a half of what it was in the first six months. But it's still a nice gain in months 7-12. 3-4% for 6 months means that the yearly rate would be 6-8% which is getting close to Forteo treatment yearly increases isn't it? Nothing to sneeze at or dismiss because of the statement that most bone building occurs in the first several months.

Maybe it's the P1NP that spikes quickly and then returns to normal that has everyone thinking it can't be building bone because the P1NP is no longer elevated. Maybe that means that it's functioning as an anti-resorptive and not building new bone but maybe we just don't understand it well enough. Maybe after that P1NP spike it keeps building bone despite the P1NP dropping back down quickly. Seems to me the important point is that the increase in bone density continues quite nicely. I go with the DXA scores on this one. The 13% gains they got for one year in two large studies and the reduced fracture rates. I'm getting a DXA this coming week. Fingers crossed.

@awfultruth