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High anxiety regarding Reclast or Prolia decison for OP meds

Posted by 255anny @255anny, Aug 18, 2024

I am overwhelmed with making this decision. Currently on Evenity, 2 more injections left. Severe Osteporosis. Spine -4.7. I left my OP Dr's office last week with an order for Prolia starting Oct/Nov. And blood work orders. We did discuss Prolia vs Reclast but I didn't ask enough questions I guess, despite having a 1 hour appt with her. I did know and told her I feared Prolia. She relayed how much easier it was than Reclast. And the Reclast stays in your system much longer. She wrote the RX for Prolia for 1 year, then relay to Evenity again. That does not sound right to me. I can't find any studies supporting that drug sequencing. This Dr is new to me but in the practice of the most respected Endo offices in my state. She only see OP patients. I am staying up til 3am every night reading and researching. There is no right answer.

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mayapath2health | @mayapath2health | Nov 5 1:41pm
In reply to @mayblin "@mayapath2health It is great that you’re getting a timely DEXA. Hopefully the results will be available..." + (show)
Profile picture for mayblin @mayblin

@mayapath2health
It is great that you’re getting a timely DEXA. Hopefully the results will be available for your appointment with the new endo.

To me your CTX looks quite high right after completing 12mo Evenity, though your baseline CTX was very high. Without a corresponding P1NP, it’s hard to tell whether this is balanced high bone turnover or active bone loss, definitely ask about this at your appointment.

FRAX score can be calculated by using: https://www.fraxplus.org/calculation-tool

Many endocrinologists use FRAX in complicated cases to guide treatment decisions.

It’s easier for a decision if you just need to lock in gains.

If you need more bmd improvement based on your new endo’s assessment, it becomes a lot trickier. If this is the case, discuss all possible route, including the usual Reclast/prolia, the lesser used risedronate/raoxifene/estrogen and tymlos/forteo, for continued bmd improvements or as a “bridging” agent.

I’d also make sure there’s an open line of communication with your new endo, sometimes these visits go by quickly, and it’s hard to cover everything in one session, especially if follow-up appointments are months out.

Best of luck!

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@mayblin They said 3-4 weeks for DEXA results. Ugh. Am going to see if my Endo can expedite as decision needed on next steps sooner than that. Will ask new Endo re CTX/P1NP. When I calculated FRAX it only calculated for femoral neck (not my super bad spine) and gave me 10 yr probability of major osteoporotic of 14% and hip fracture 3.6%...but that was using data prior to my rib fracture (bent over and twisted to get something in a tight airplane seat about 9 months after the DEXA and broke two ribs)...if I add that factor (again was 9 mos after the scan) it moves to 23% and 6.4%. Likely I am going to be one of the 'trickier' cases. Scary.

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clowny | @clowny | Nov 5 5:02pm
In reply to @willow5 "I see the endocrinologist tomorrow. I think he prescribes reclast. Saw my PCP yesterday and her..." + (show)
Profile picture for willow5 @willow5

I see the endocrinologist tomorrow. I think he prescribes reclast. Saw my PCP yesterday and her protocol is prolia. Wish i had thought to ask her why.

After a year on evenity i’m osteopenic everywhere except the left femur. I’m just below the osteopenia range. Whatever I do to lock in the gains (they were largest in the spine) does that mean i will no longer build bone? Hoping my weight lifting will continue to help.

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@willow5

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clowny | @clowny | Nov 5 5:03pm

My doctor is recommending Reclast.
One infusion annually for 3 years

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mayapath2health | @mayapath2health | Nov 17 3:54pm
In reply to @mayblin "@mayapath2health It is great that you’re getting a timely DEXA. Hopefully the results will be available..." + (show)
Profile picture for mayblin @mayblin

@mayapath2health
It is great that you’re getting a timely DEXA. Hopefully the results will be available for your appointment with the new endo.

To me your CTX looks quite high right after completing 12mo Evenity, though your baseline CTX was very high. Without a corresponding P1NP, it’s hard to tell whether this is balanced high bone turnover or active bone loss, definitely ask about this at your appointment.

FRAX score can be calculated by using: https://www.fraxplus.org/calculation-tool

Many endocrinologists use FRAX in complicated cases to guide treatment decisions.

It’s easier for a decision if you just need to lock in gains.

If you need more bmd improvement based on your new endo’s assessment, it becomes a lot trickier. If this is the case, discuss all possible route, including the usual Reclast/prolia, the lesser used risedronate/raoxifene/estrogen and tymlos/forteo, for continued bmd improvements or as a “bridging” agent.

I’d also make sure there’s an open line of communication with your new endo, sometimes these visits go by quickly, and it’s hard to cover everything in one session, especially if follow-up appointments are months out.

Best of luck!

Jump to this post

@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?

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mayblin | @mayblin | Nov 17 8:47pm
In reply to @mayapath2health "@mayblin Hello...so my DEXA came in on Friday and is as follows: Nov 2025 (63 yo):..." + (show)
Profile picture for mayapath2health @mayapath2health

@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?

Jump to this post

@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.

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