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The Doctors Reply after Prolia AFF and now recommends Forteo
Osteoporosis & Bone Health | Last Active: Oct 27 11:12am | Replies (16)Comment receiving replies
@sbax75 this may be obvious but Prolia poses the risk of fractures in two ways. The first is your experience AFF fairly rare. It happens because Prolia form weaker, avascular bone. It stops the normal process of bone remodeling. Your doctor is right in thinking that you have risk in the unfractured femur.
Fractures from the second risk happen when you stop taking Prolia. The way that Prolia prevents this process of rebuilding is peculiar to Prolia. It stops the osteoclasts-- the acid emitting cells that break the bones down. It stops them in the last stage of development. And they collect. You have six times as many preosteoclasts as you would without having taken Prolia. But they are held in abeyance until you stop the drug.
Fractures from the second risk are common, rare not to have in multiples mainly in the spinal vertebrae. In my thinking these osteoblasts are your greatest risk over the next 3 to 6 months. Bisphosphonates are the drug that best destroys them. Evenity halts the osteoblasts at an earlier stage of development and so cannot prevent the onlslaught of those preosteoblasts from Prolia use. I wouldn't want Reclast because of it's long term effect on your bones. I would take an oral bisphosphonate or IV Boniva starting right away with the intent to take Tymlos or Forteo as soon as possible. The effect of either of the anabolics will be blunted or slowed down, but still will have some protective effect that will overtake the blunting bisphosphonate.
You might want to request bone markers. The broken bone will confound the results, but will give you the progress of the osteoblasts and osteoclasts, allowing you to adjust bisphosphonate dosage. When the osteoclasts subside, I would stop the bisphosphonate.
Your doctor makes sense. She is aware of the accrued effect of bisphosphonate after Prolia on AFF for the un fractured leg.
I do wish she had challenged the insurance denial. You might ask her to get a courtesy Tymlos pen from the drug rep. because I don't think you should wait, even without knowing how long it has been since your last Prolia.
Connect is at it's best when we challenge each other's thinking. Anyone reading this should question it most helpfully in a post.
@abax75, I hope your fracture is healing well. I think that you can get out from under this temporary danger without further pain.
When was your last Prolia shot. At six months you
Replies to "@sbax75 this may be obvious but Prolia poses the risk of fractures in two ways. The..."
Started 6 month Prolia in September 2022. Seems scary with all the information on Prolia here. I have a stage 3 prostate cancer that I cannot remove. I have been on Orgovyx since May 2022. Very successful with it. I will talk to my cancer doctor about the Prolia at my next 3 month checkup.
Thank you so much for your thoughtful reply. The end of your reply didn't post-it just read's "at six months"
But to answer your question:
My last shot was due a week after the fracture. I am now three week from when the last Prolia shot should have been given. Oral bisphosphonate were not tolerated, years ago. You write: "I would take an oral bisphosphonate or IV Boniva starting right away with the intent to take Tymlos or Forteo as soon as possible."
Do mean to do this as a combination therapy? Or just start Forteo as soon as possible?
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@sbax75 After 6 years on Prolia, I wonder if Reclast is the only way to deal with rebound. What a bind to be in.
@gently interesting fact on Evenity suppressing osteoclasts at an earlier stage of development.
If had been one year of Prolia, you could discuss Evenity with your MD because there is some study on that.
It seems bisphosphonate then either Evenity or Tymlos / Forteo but then more bisphosphonate will be needed. Prolia won't be an option.
The fact remains that Tymlos and Forteo are not effective after Prolia (especially after 6 years ?), and fractures may result. Evenity is uncertain after longer term use of Prolia, as @gently described. So the questions are 1) Is an oral bisphosphonate strong enough to combat rebound and 2) what cumulative effect does repeated bisphosphonate use have an atypical fracture risk? and 3) What other choices do you have? (Maybe ask about how Raloxifene might fit in this whole scenario?)
ps I hope you can have a DEXA on the unfractured side!