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@gravity3
As you know, your prior Fosamax exposure (Langdahl's presentation} and ongoing HRT both provide added protection against rebound that can occur after stopping Prolia. The challenge is, for this specific situation, there is no solid evidence supporting a reduced dose of Reclast. I agree with your inclination that 5mg is the safer approach.
No major US medical society specifies a numeric CTX threshold during Prolia cessation; in Europe, the ECTS proposes a CTX of 280ng/L as the Reclast retreatment trigger, a later analysis by Grassi et al. identified 212ng/L as the cutoff most predictive of subsequent bone loss. Those thresholds, however, vary across studies and cohorts.
To me, transitioning to Reclast (guided by CTX) seems more straightforward since you may be able to take a drug holiday once rebound risk has passed, with Evenity remaining an option if needed later.
Continuing with Prolia is another reasonable strategy if you are comfortable doing so and have with an exit plan in place just in case. There are a few limited observational studies published recently, one involving the addition of Evenity to ongoing Prolia, and the other using overlapping Evenity with Prolia. Both showed some success in patients (small #s) at very high fracture risk. Those approaches may not be particularly relevant to you if you are responding well and have remained fracture-free.
Please keep us updated on your next DXA results and decision - your endo may have a preferred med based on your bmd and FRAX risk after the scan.
Replies to "@gravity3 As you know, your prior Fosamax exposure (Langdahl's presentation} and ongoing HRT both provide added..."
@mayblin I read your reply with great interest because you are the only person, besides my endocrinologist, who mentioned the 280ng/L CTX reading as the key number in evaluating the need for another Reclast infusion. You also mentioned another analysis used 212.
I recently saw my endocrinologist who looked at my CTX scores (baseline plus 2 additional readings) and saw my most recent CTX was 283. She said that she recommended another Reclast infusion now. Had I taken her advice, I would be doing one now, but I'd prefer to wait a full year since my original and first Reclast infusion in October 2025. I'd like another Dexa scan before deciding about when to do the next infusion, but that will depend on Medicare coverage since it's not been 2 years since my last one.
When I asked her about referring to 280 as a significant threshold, she said it was used in Europe. With your more specific reference to ECTS I could find out more about this group which describes itself this way:
The European Calcified Tissue Society (ECTS) is the major organisation in Europe for researchers and clinicians working in the musculoskeletal field.
https://ectsoc.org/about-ects/
If you can provide a reference to the ECTS referral to the 280, I'd really appreciate it. But if you can't do that, no worries. In looking for that, however, I did find
"A position statement by ECTS on Discontinuation of Denosumab therapy for osteoporosis – by Carola Zillikens."
While no mention of that 280 is in this statement, this comment caught my attention even if the number of women was incredibly small:
"A recent very small study of six women with postmenopausal osteoporosis who had been treated with denosumab for 7 years showed that a single infusion of zoledronic acid was not able to prevent BMD loss at the femur. Studies to investigate the optimal timing of starting i.v. bisphosphonates as well as on the duration of this post-treatment period are clearly needed."
https://ectsoc.org/a-position-statement-by-ects-on-discontinuation-of-denosumab-therapy-for-osteoporosis-by-carola-zillikens/
Thank you for providing this information!
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@mayblin
Thank you so much. This is such valuable information. I appreciate your help in trying to sort this out.