Reclast vs Prolia question

Posted by brendammc @brendammc, 6 days ago

Getting prepared with info before appointment. I’ve read that Prolia may not rebound if only on it 2 years? And Aclasta has no rebound but both have the caution of ONJ. If going to start on one over the other is there a better? I won’t likely be able to take an oral medication for relay.
I’d prefer to take Forteo or generic first but coverage is very hard to get where I am. Have to have had ONJ!!! from another med first. I’m trying to decide if I’d pay for myself but??$$.
So complicated. I’m hoping I can get some input here before I see the specialist so I have some knowledge. I’ve done lots of research but find this site narrows it down in simpler terms. Thank you!

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

Profile picture for brendammc @brendammc

@mayblin thanks so much. Is the bone turnover for baseline the CTX or the P1NP? I believe calcium levels need to be checked before starting? Blood and urine?

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@brendammc,

Many endocrinologists check blood calcium (and vitamin D) before starting treatment or at the time of diagnosis. A 24-hour urine calcium is often included to help rule out secondary causes, and your endocrinologist will likely order an extensive panel of labs to screen for any underlying conditions contributing to osteoporosis, if this hasn’t been done already.

The bone markers I was referring to are CTX and P1NP, which are the two most commonly used to assess bone turnover, although the testing is not yet a standard clinical practice.

That said, given your T-score of –4.7 and two vertebral fractures, the priority should really be getting access to an anabolic therapy (Forteo or Evenity in Canada). This is the most effective way to build bone and reduce fracture risk in someone at very high risk. Which antiresorptive to follow afterward (Reclast vs Prolia, etc.) can be decided later, once the anabolic course is completed. If an anabolic is not possible, note that Prolia usually isn’t used as first-line therapy, so that’s something to discuss carefully with your doctor.

Good luck with your treatment discussions, I hope you find a plan that works well for you.

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Profile picture for mayblin @mayblin

@brendammc,

Many endocrinologists check blood calcium (and vitamin D) before starting treatment or at the time of diagnosis. A 24-hour urine calcium is often included to help rule out secondary causes, and your endocrinologist will likely order an extensive panel of labs to screen for any underlying conditions contributing to osteoporosis, if this hasn’t been done already.

The bone markers I was referring to are CTX and P1NP, which are the two most commonly used to assess bone turnover, although the testing is not yet a standard clinical practice.

That said, given your T-score of –4.7 and two vertebral fractures, the priority should really be getting access to an anabolic therapy (Forteo or Evenity in Canada). This is the most effective way to build bone and reduce fracture risk in someone at very high risk. Which antiresorptive to follow afterward (Reclast vs Prolia, etc.) can be decided later, once the anabolic course is completed. If an anabolic is not possible, note that Prolia usually isn’t used as first-line therapy, so that’s something to discuss carefully with your doctor.

Good luck with your treatment discussions, I hope you find a plan that works well for you.

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@mayblin thanks. I guess with my fractures my bone markers aren’t a priority at this point.
I am really hoping for the anabolic.
Now I’m just trying to heal my gut and not fracture but doing some careful exercises too.
Thankfully I can walk. ☺️

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Profile picture for brendammc @brendammc

@broken13 thanks for your reply. Could you share what province you are in? And was your Forteo covered?

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@brendammc I live on the Sunshine Coast in B.C. My Forteo was 80% covered and my generic version fully covered. I have extended health through Blue Cross

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Profile picture for broken13 @broken13

@brendammc I live on the Sunshine Coast in B.C. My Forteo was 80% covered and my generic version fully covered. I have extended health through Blue Cross

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@broken13 thank you for your reply. I think this group is keeping me sane while I wait. Also am gaining a lot of knowledge. I envy you from Alberta for your wise Dr Henry. I’m hopeful I’ll be successful in coverage.
(And lucky you where you live. I was born in PR. )

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