I am not going get a REMS until doctors begin to accept or prescribe based on REMS. I am not saying I do not trust the REMS, just that it is not accepted in the US medical establishment. I also do not see a physician for my OP, because I am confident right now that what I am doing is positive. No fracture history and no cancer history. My younger sister started on meds years ago and never had any solid response until a year of evenity. She was advised to go on prolia as a follow up and chose not to. Her lumbar spine is 5.1 now and her doc is advising reclast. She is undecided. She is in a tough spot because she has taken all these meds, and yet never fractured. It is a lot of years to be on these meds. Good luck