← Return to The Doctors Reply after Prolia AFF and now recommends Forteo

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@awfultruth

@sbax75 Your difficulty brings up a problem I hadn't considered. How to deal with the difficulties of dealing with the dangers of stopping Prolia and the damage (atypical femur fractures) caused by mainly antiresorptive osteo meds at the same time. What I'm going to say below is rather speculative and I have not been in your shoes. That said, I'll speculate.

You cannot just stop Prolia without losing a lot of bone, that's for sure. And some people don't just lose a lot of bone but they have multiple fractures.
So,
On the one hand the safest known way to get off of Prolia is with Reclast.
But on the other hand if you have already been on Prolia 6 years and have had an AFF then you need to get some remodeling going in your bones. Some modest clean up and some bone building both. But not out of control cleanup like can happen with the stoppage of Prolia.

As @windyshores has just commented Forteo and Tymlos are not considered safe follow ups to Prolia. Too much bone clean up may happen and at least initially you may lose bone using either of those. That basically leaves Evenity which can hopefully get your bone building and remodeling going without the clean up side being too activated. After Evenity gives you a period of remodeling you could hopefully safely try Reclast or another bisphosphonate to preserve bone. Perhaps alternating bone builders and bisphosphonates down the road to get periods of bone building and remodeling and periods of mainly preserving the bone you have but not having such long periods of suppressed remodeling as six years of Prolia gives you.

There's one study where Evenity was given both before and after Prolia in one arm of the study. It appeared to work fine with no new safety concerns on the year of Evenity following Prolia. Those following Prolia with Evenity were able to gain more in the spine and break even in the hips. Not the same benefits as giving Evenity as the first osteoporosis med though still benefit.

But this study does not directly apply to your situation. The length of time on Prolia before the second Evenity round was only one year. Very different than six years. This is an important study with a wealth of information but one year of Prolia is just very different than six years. Perhaps there are other studies that cover a longer time period on Prolia or at least doctors who have used Evenity after years of Prolia successfully. If you have the time it could be very useful to get more information on Evenity after long term Prolia use.
Here's the paper I mentioned above: https://link.springer.com/article/10.1007/s00198-019-05146-9
I wish you the best of luck

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Replies to "@sbax75 Your difficulty brings up a problem I hadn't considered. How to deal with the difficulties..."

@awfultruth whoooaaa I am glad you pointed out that that study followed only one year of Prolia! That makes me wonder if the only safe course is Reclast for @sbax75. I wonder what info is available on Reclast's antideportation following 6 years of Prolia with an atypical femur fracture. Hoping the doctor knows the best path.