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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
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?
Replies to "Thank you so much for your thoughtful reply. The end of your reply didn't post-it just..."
sbax75, yes, combination use of both a bisphosphonate and Tymlos. The bisphosphonate will slow but not prevent the effect of Tymlos. And the Tymlos won't hinder the bisphosphonate. Like you, I think that Reclast (I like the lower dose of Boniva as well as the possibility of stopping at three months which you wouldn't have with Reclast) protects against your greatest risk.
There was a study of Reclast with Forteo. I think Mayblin posted the link.
The only trouble with second opinions is that I don't think you should wait for treatment. And the wait could be three or more months.
Your best bet might be to ask your md for the three month Boniva injection.
I erased a longer post to you that I need to retrieve.
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@sbax75 just to be clearer: it is not a good idea to do Forteo (or Tymlos) after Prolia.
It won't help with rebound/fracture risk and it won't be effective. I could cite numerous sources: McCormick "Great Bones" and Ben Leder on YouTube for starters.
Most of us do Reclast after Prolia. If Prolia has not been taken too long, Fosamax can be used. Reclast is IV once a year usually.
I have seen combination studies on Prolia and Forteo (Ben Leder "Combining and Sequential Approaches to Osteoporosis on You Tube). https://www.youtube.com/watch?v=WXoz1NeUgg8
At minute 7:15 combo of alendronate (Fosamax) and Forteo is discussed as having no significant advantage but this does not deal with using that combo after Prolia. If anyone has a study on this, or if your doctor does, taht would be key.
At minute 36:05 there is a chart showing what happens going from Prolia to Forteo which shows a plunge in bone density which Leder says is even WORSE than the rebound after Prolia with no drug.
Unfortunately Prolia use for a few years with an atypical femur fracture presents a dilemma that I think is beyond the scope of this forum. It is very important to have an MD who understands the complexity of this situation. Forteo may not be a good option so maybe a second opinion would help.
Amateur advice would be use of CTX testing to time a Reclast infusion to minimize harm and maximize benefit, and then seek advice on when an anabolic (Evenity, or preferably Forteo or Tymlos) might be possible if you still need bone meds. Of course after any of those you will again need a bisphosphonate. A doctor should be able to tell you if there is cumulative effect and continued risk of AFF using a bisphosphonate for any period of time after Prolia- though it may not be known!