Hi @kgrainger - Well, not being able to use Reclast leaves fewer options. I can think of four options with today's medications.

1. Stay on Prolia. Long term use seems safe and effective.

2. Use Fosamax. Make sure you wait 2 hours after each weekly tablet before you have breakfast for best absorption.

3. Evenity has been show to be effective to transition off Prolia for short term usage. I have not seen long term data but it's going to be much better than not having a treatment

4. Ween off Prolia with decreasing doses. There was a very small study that Dr. Langdahl presented at the 2024 World Congress on Osteoporosis showing some success in reducing the dosages of Prolia toward the end of treatment. There was however significant variation to individual responses to the strategy. Attached is a snapshot from the presentation. You can search the reference on the bottom the slide to find the trial data.

I hope this helps.