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Second reclast infusion after 6 months

Posted by debber51 @debber51, Jun 2 4:50pm

I received Prolia injections every six months from 2016 until the end of 2025 with excellent results. I went from significant osteoporosis to osteopenia. My rheumatologist recommended i stop the Prolia (because i was on it so long) and receive a Reclast infusion within 4 months of my last Prolia injection, which i did in December, 2025. I had a severe reaction following the infusion for 5 days with fever, chills, body and headaches, followed by 2 weeks of fatigue. My rheumatologist did bloodwork in May which indicated that the Prolia was out of my system but the Reclast absorption was low. She therefore recommended an interim infusion in June plus another one in December of this year. My endocrinologist disagreed with this recommendation, explaining that Reclast is a powerful drug meant for once-a-year administration, and that my numbers did not indicate that I should receive another Reclast infusion so soon. Any thoughts on which doctor i listen to?

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leslie559 | @leslie559 | Jun 2 5:04pm

Did your blood work include the important, and often overlooked, CTX and P1NP. Those would be good indicators to have to know if you need to do your Reclast sooner.

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debber51 | @debber51 | Jun 2 6:39pm
In reply to @leslie559 "Did your blood work include the important, and often overlooked, CTX and P1NP. Those would be..." + (show)
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Did your blood work include the important, and often overlooked, CTX and P1NP. Those would be good indicators to have to know if you need to do your Reclast sooner.

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@leslie559 Yes I believe so. Endocrinologist said the turnover markers were slightly low but not an indication that the Reclast had to be repeated early.

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gently | @gently | Jun 2 7:55pm

I'd side with the endocrinologist except:
You started Reclast while Prolia was still strongly suppressing the bone. Reclast depends upon resorption sites in order to cling to the bone. Prolia pretty efficiently prevents resorption sites from forming. So most of your first dose of Reclast (after making you miserable) probably washed out of your system.
So you see how it could make some miserable sense to take another dose of Reclast, still you must be reluctant.
I'd want to continue to monitor the markers until it became a little more clear what your body did with this unusual application of the Reclast.
Some doctors wait until the 6th month to ascertain by bone markers that Prolia was no longer active in your system. Then sometimes they will wait a month or so on a less intense bisphosphonate before beginning Reclast. It is important now to keep track of CTX or NTX so that you know if Reclast was a washout and you might be needing protection from Prolia rebound fractures.
I wouldn't accept another full dose of Reclast in any event. You might need to insist on a very low dose 1 or 2 mg with a long infusion at least 30 minutes. And after you'd want to continue to track the markers of bone resorption in case you'd benefit from another 1 mg of Reclast.
Very interesting. I'm so curious to know what you decide to do.

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