I put the question about Prolia follow up meds into ChatGPT. It isn’t always 100% correct, but I always find it's a great place to start researching. Best wishes.

Yes, after stopping Prolia (denosumab), everyone is at risk for "rebound bone loss" and vertebral fractures—regardless of age. That’s why it’s generally recommended that another osteoporosis medication be started immediately after Prolia is stopped, unless there is a strong reason not to.

Why This Matters:

Prolia suppresses bone turnover very effectively, but once it's stopped, bone resorption can rapidly increase—often faster than before treatment, leading to a high risk of fractures, especially multiple vertebral fractures.

This rebound effect is not limited to older adults. It has been seen in younger people as well, including premenopausal women and men who were on Prolia for certain conditions (e.g., cancer-related bone loss, glucocorticoid use).

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What to Take After Prolia:

The typical follow-up medication is a bisphosphonate like:

Alendronate (Fosamax)

Risedronate (Actonel)

Zoledronic acid (Reclast) – a once-yearly IV option

These help “lock in” the bone density gains from Prolia and blunt the rebound effect.

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Are There Exceptions?

There are very few. A younger person may be at lower absolute risk of fracture due to higher baseline bone density, but if they were prescribed Prolia, it usually means their bone health was significantly compromised to begin with. In such cases, stopping Prolia without follow-up medication is still considered risky.

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What You Should Do:

Plan for a transition: If someone is considering stopping Prolia, work with a doctor (usually an endocrinologist or rheumatologist) to schedule follow-up treatment.

Timing is critical: The next medication should usually be started within 6 months of the last Prolia injection—sometimes sooner.