Switching from Prolia to Evenity

olk, the research is mixed on whether Evenity can prevent rebound from Prolia. The risk is greater after 2+ years on Prolia. I wouldn't take that risk.
Prolia stops the maturation of osteoclasts(the cells that break down bones) at the very last stage. Evenity blocks sclerostin which prevents the development of new osteoclasts. When you stop Prolia the very large collection of osteoclasts in the very last stage of maturation, mature rapidly and are unleased on your bones. By mechanism, Evenity cannot stop them. An additional problem with the four year reservoir of osteoclasts is that they combine with other osteoclasts and to become large bone eating cells. Some have multiple compression fractures called cascade fractures one after the other.
Reclast the strongest protection against rebound might be something to consider. It has some drawbacks as far as side effects, so you'd want to look a the literature on this site carefully before deciding. You could switch back to Prolia after the first month if you had a bad reaction to Evenity.
I'd rather see you add Forteo to the Prolia for the next six months and then take a lower 4mg dose of Reclast with a long (one hour) infusion.
You might ask for bone markers. They can save us the pain and cost of medications that aren't effective for us.
I hope you get many different responses to mull over for the next three weeks.
Welcome to Connect and
Bless your bones.

be VERY careful stopping Prolia. be sure your doctor is checking bone markers ( beta CTX and P1NP) regularly and frequently beginning 4 months ( not 6 mos … rebound can start early ) after last dose of Prolia. I your doctor doesnt have a clear strategy. get a doctor who is all over this rebound and how to stack therapies if needed to stop it.
Reclast is my choice after much research and consultation.

This discussion is very helpful to me...
I have been on Prolia for 4.5 years (almost 5). I want to get off, but my doctor told me to stay on it since there is no medically-approved transition strategy after such a long time. I have no choice but to continue, as long as I stay with the same doctor who is a renown osteoporisis expert. She mentioned a possible transition to Reclast, eventually, once a medical establishment comes up with a strategy (who knows when).
I was originally allergic to Tymlos, and Forteo is contraindicated, according to her.
Another expert, Dr. Keith McCormick, recommends stopping Prolia immediately and transitioning to Reclast supported by frequent CTX tests. Unfortunately, Dr. McCormick is only a consultant now, he does not see patients.
I don't know what to do. With every additional Prolia injection, getting off it will be more questionable.
Any suggestions?

I'd want to transition off Prolia. Some people simply stay on the medication for always. The trap is if you have to stop because of ONJ or AFF, there is no transition because Reclast has the same effect. You might transition to Reclast, watch the bone markers leap to an anabolic after one or two years.
The freedom trial gives us information that Prolia is safe and effective most up to ten years.
I'm finding your renowned expert's advice interesting. If she is renowned by publication, can you give us a link, or a name. I'd like to understand her thought. I wonder if it is because the risks affect such a small percentage of the population and/or if she sees something new on the near horizon.

I just got on Prolia 3 weeks ago after an MRI found 2 thoracic compression fractures and mutiple issues in my lumbar including L4/5 narrowing and sacroiliitis. The doctor told me there are no side effects of Prolia and to come back in 6 months. After going home and reading about all the side effects, I immediately changed to a different hospital and spine specialist. My question after reading the above posts: Is it safe to switch from Prolia to Zoledronic acid (the annual IV infusion) at the end of the fist six months of prolia? And is it safer than Prolia? Most of thesee medications say they prevent further bone loss, but only Evenity says it does that and also builds bones. However I have hypertension so I guess I can't take Evenity.

aldo2, Reclast is the safest drug to transition to after Prolia. After just one injection of Prolia, you are thought to be safe from Prolia rebound. So you switch to a different medication. There aren't that many medications. You ruled out Evenity but youcould have,
the reclast infusion
oral bisphosphonate
Tymlos or
If you read the possible side effects with Reclast you'll worry. Remember, though, that some (the many) don't have terrible side effects with Prolia or Reclast.
I can recommend Forteo because it was my choice and in my opinion the best available medication. Tymlos, I haven't taken, but consider the second best available medication.
Forteo builds fresh bone, first removing older fissured bone.
I admire the alacrity with which information motivated you to change specialists.
You should hang out here with us. We have a spectrum of ideas.