Just sharing my experience with RECLAST infusion. I had my DEXA Scan in Nov 2023 and since the result showed drastic thinning of bone density, I was advised to have the infusion. I took it the following month Dec. two weeks I had it done (first time), after less than 2 weeks my supposedly mild osteoarthritis on the left knee swelled and I could not even walk and it hurts when I put my weight on it. Although the swelling is gone (but still have a mild inflammation) now to date (Sep 2024) 9 months, I am still experiencing the pain/achiness and the inflammation has not really gone away. I am 65 years old and never had any problems with my arthritis. I Have always been active and always on the go until I had Reclast. I hear you ladies— and also feel your concern regarding the meds and treatment.

If your osteoclasts have not started increasing after Prolia cessation, it seems most logical to wait until that happens before starting Reclast.

I say logical not just because high/rising CTX numbers appear to be associated with the Prolia 'rebound' affect. But also for the reason given by McCormick that you DO need a certain level of osteoclast activity (he likes a CTX greater than 100) to prepare a good foundation for the osteoblastic bone-building activity.....so that you are building strong bones, not just dense bones.

I am always scratching my head about the number of fractures that are reported to occur in the osteopenia range of BMD scores. Bone density and bone strength do not appear to be equivalent.

Here, however, you are searching for numbers that would indicate when Reclast is appropriate. Has your endo suggested any such CTX number or is s/he saying Reclast is simply required 6 months after the last Prolia injection?

McCormick would seem to be happy with a CTX score between 100-375, Great Bones at p. 144, so I would think anything above 375 is when I might consider Reclast. But then, I do not like taking meds unless absolutely necessary.

A number of folks who post here on Connect do not think there is a 'too low' CTX number, which may mean the CTX number is not relevant for determining timing of Reclast. But I am not in that camp (because I think strong bones are more important than dense bones to reduce fracture risk) and would wait for a test showing increased CTX numbers.

If your bond-building marker (P1NP) is also low (McCormick thinks low is less than 30) then I would look for secondary causes of bone loss and try to figure out a way to increase that number.

I suspect there is an important, perhaps even critical, relationship between osteoclast activity and osteoblast activity for producing strong (not just dense) bones but have no idea what that might be or what a BMT results ratio might look like.