What are some situations where Prolia is a very good choice?

For some people, Prolia worked and didn't have side effects. The issue with all of these drugs is that they are great for some people but not for others, and there's no way to know until you try it. 🙁

Prolia may be a good choice if you can stay on it and are old enough to take it "for life", and also if you cannot tolerate other meds and it is the only option- according to my doctor and several sources ("Great Bones" by McCormick, Ben Leder MD on YouTube).

The issue that is most discussed with Prolia is rebound. Stopping it brings risk of fast drop in bone density and increase in fracture risk. This is well-known and appears in numerous sources, and my doctor has told me he does not like to use it for this reason.

Secondarily, people seem to end up between a rock and a hard place because:

1) Reclast (or possibly alendronate, but Reclast is stronger) is needed after Prolia to mitigate rebound. If you have already done the maximum time on bisphosphonates, or cannot tolerate them, you are in a pickle- according to my doctor and quite a few posts here on Mayo Connect. It is possible studies may show that Evenity can be taken after Prolia and help with rebound. One study was posted on that here. ( Note: It seems people are posting about McCormick, author of "Great Bones" suggesting that 1-3 Prolia shots are safe in terms of rebound and that Reclast or alendronate can then safely mitigate rebound.) So if you do, say, 5 shots and have side effects, what do you do next if you cannot do a bisphosphonate?

2) Apparently according to both McCormick, Forteo and Tymlos aren't very effective after Prolia. So options after stopping Prolia may be limited, if bisposphonates aren't possible. Again maybe Evenity will help (but Reclast/alendronate or Prolia is given after Evenity). Bisphosphonates are limited to 3-5 years.

Prolia has been studied for 10 years now and as the study progresses, the allowed duration of Prolia treatment extends. If you can tolerate it, and are, say, 80+ years old, Prolia might be a great life-long option. Also, if you cannot tolerate any other medication or have health issues that are a contraindication for every other medicine possible , that is when my doctors will consider using it.

I am another osteoporosis patient and the best source of information is your doctor. Since I have not taken Prolia, I can only post what my doctor has said and the info gleaned from the two sources I favor, McCormick and Leder. Many seem to like OsteoBoston as well. I do not have personal experience with Prolia but wanted to respond as a fellow sufferer who is thinking about long term options.

I am so tired of the myopic approach to osteoporosis. We are so much more than just our bones.

Those of us with weakened immune systems are at risk with Prolia but there is almost silence about this. This is from drugs.com.
"Yes, Prolia (denosumab) does appear to weaken your immune system. Research has shown people who take Prolia are at an increased risk of serious infections leading to hospitalizations, including serious infections of the skin, abdominal, urinary tract, and ear. There is also a higher chance of developing endocarditis (an infection of the heart’s inner lining, usually involving the heart valves) in those who take Prolia, and those with advanced kidney disease have an increased risk of severe, life-threatening, low calcium levels (hypocalcemia) developing, particularly if they have a metabolic condition called chronic kidney disease-mineral bone disorder (CKD-MBD). For some side effects, people administered concomitant immunosuppressant agents (such as prednisone or cyclosporine) or with impaired immune systems may be at an even higher risk.

Doctors may need to consider discontinuing Prolia in people who develop serious infections or other severe side effects."

I am finding that many of these drugs have potential heart issues like forteo an tymlos can cause heart palpitations. What I want to know is that considering the person and what drugs they have been on and their health situation, are there instances where Prolia should be selected?

I don't have personal experience with prolia either. Some of the members on this forum are doing 1-2 shots after evenity in hoping to increase bmd further then "lock-in" with reclast afterwards - I read that as a strategy in publications as well.

IF the very rare ONJ or AFF happens after a long term prolia treatment, doctors and patients will need to deal with prolia rebound which is largely managed by a strong bisphosphonate such as reclast, and the dilemma of choosing next best osteodrug going forwards at the same time.

Would like to add here, evenity after prolia (only up to 2 shots of prolia) was studied for bmd changes as end results. Whether or not evenity could mitigate prolia rebound to any degree wasn't mentioned in the study. I have the paper somewhere and will post the link if I could find it.

@serious I have atrial fibrillation with heart rate up to 200, sporadically. The entire two years on Tymlos I didn't have a single episode, which was unexpected but welcome.

I do not have personal experience as mentioned above but from my doctor, books, videos and fellow posters (including @mayblin) I think a summary would be, that Prolia is a good choice if:

1) you can't take anything else
2) you do 1-3 shots then Reclast
3) you do 1-3 shots after Evenity (for a boost) then Reclast
4) you can do 10 years (or more as studies progress) if you are old enough to think you won't have to stop.

As with all drugs, some people have side effects, but the main concern is the dramatic rebound loss of bone density and increase in fracture risk. Also know that it may affect future effectiveness of Forteo, Tymlos or Evenity.

My doctor jokes that he will prescribe Prolia when he is retiring so he doesn't have to deal with rebound. That said, it is pretty effective at boosting bone density as an anti-resorptive.

ps I have had cancer, and have lupus and high antibodies for scleroderma so Prolia is concerning for me, personally, due to the fact that it works with RANKL and may affect the immune system.

Posting that paper would be appreciated.

Yes, I second that!