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High anxiety regarding Reclast or Prolia decison for OP meds
Osteoporosis & Bone Health | Last Active: Nov 17 8:47pm | Replies (205)Comment receiving replies
@mayblin Hello...so my DEXA came in on Friday and is as follows:
Nov 2025 (63 yo):
Spine: BMD is measured in L1-L4.
T-Score: -2.7
Z-Score: -1.1
Change versus previous: 16.8%*
Left Hip: T-Score of hip is lower in femoral neck.
T-Score: -2.1
Z-Score: -0.7
Change versus previous: 9.3%* (total) Change versus previous: 16.5%* (femoral neck)
As reminder my January 2024 DEXA was:
Age 61
Spine L1-L4: T-score -3.7; Z score -2.2
L1 T-score -2.6; Z score -1.3
L2 T-score -3.7; Z score -2.2
L3 T-score -4.0; Z score -2.5
L4 T-score -4.3; Z score -2.7
Left neck: T-score -2.9; Z score -1.5
Left hip: T-score -2.4; Z score -1.4
FRAX 10 year probability of fracture: “not reported because some T scores…below 2.5”
L3 T-score -4.0; Z score -2.5
L4 T-score -4.3; Z score -2.7
Left neck: T-score -2.9; Z score -1.5
Left hip: T-score -2.4; Z score -1.4
FRAX 10 year probability of fracture: “not reported because some T scores…below 2.5”.
I also had Osteocelin results: 22ng (in 2024 had been 17 ng).
Dr is suggesting Prolia...and have scheduled for this afternoon as it's already 4+ weeks since completed Evenity and he said important to not let slip. Any last minute thoughts? I can cancel Prolia appt but hard to get another?
Replies to "@mayblin Hello...so my DEXA came in on Friday and is as follows: Nov 2025 (63 yo):..."
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@mayapath2health
Congratulations on the great BMD improvements with Evenity, gains were seen at all bone sites, how wonderful!
Your recent labs show that bone resorption is still quite active (CTX), while bone formation (osteocalcin) is moderate. As your endocrinologist pointed out, it’s important to start an antiresorptive drug now to protect the gains you’ve achieved with Evenity.
Given your prior fracture history and current labs, your endocrinologist has likely already weighed the best strategy moving forward. Your post-Evenity FRAX has probably improved, so you may now be entering more of a maintenance phase, where the main decision is which antiresorptive - Prolia or Reclast - fits you best. Other antiresorptives might not be strong enough for you given your high CTX (both at baseline and 1mo post evenity).
Prolia has been studied for 1–2 years after Evenity and has shown continued BMD gains. Whether used short-term or longer, Prolia always needs to be followed by a bisphosphonate such as Reclast or Fosamax to prevent rebound bone loss if you ever need to stop it.
Reclast provides durable bone protection with once-yearly dosing, though it should be used with caution in people with kidney issues.
In the end, the decision really comes down to your preferences and a discussion with your endocrinologist about what fits your situation best.
If another round of anabolic treatment is ever needed in the near future, Reclast may offer a more straightforward path, but it doesn't sound like that's part of the plan right now. Moreover, very few clinical studies exist to guide this sequencing path, i.e., evenity to reclast to another anabolic.