Switching from Prolia to Evenity

I am also wondering about making the switch from Prolia (been on it for 9+ years) to Evenity. Is it ok? Also, is Evenity safer when doing dental extractions and has a lower chance of ONJ than Prolia?

mariam58, Evenity is safer, partly because we only take it for a year. But the risk is cumulative. The bone we build with Prolia is modeled bone. It doesn't allow the cells that remove fissured bone to be released. Consequently, the bone becomes avascular and brittle. All the while Prolia is collecting the cells that remove bone in the final stage of development where they collect and sometimes combine becoming large cells that destroy bone. When you stop Prolia all those collected cells are released on that already avascular bone. Now, Evenity stops new osteoclast cells from developing, but it doesn't prevent the developed cells from being released. Because of these mechanisms, I don't think Evenity is a safe drug to follow Prolia. It can't protect you from rebound and won't alleviate the risk of ONJ with invasive dental work.

@gently
Could you possibly give me your thoughts. I came off Prolia after ten years, had Reclast infusion then a year with nothing other than bone building exercise & calcium, D3. T score in spine dropped to -3.9 (14%) in hip -2.9 (12%). Endo ordered spinal x ray. Healed compression fracture from time near end of Reclast year. Blood test also ordered. CTX & PINP in normal range.
Seeing endo next week. She wants me to go into Tymlos. I’ve had breast cancer radiation 22 years ago so am concerned. I’d prefer to try Evenity. Do you think the bloods show rebound has finished? Which drug might be better? I’d be willing to risk the radiation side effect if Tymlos is superior in this instance.

Happily, just remember that I've no medical background,
I'd rather see you on Tymlos because of the way each of these medications build bone.
Tymlos builds bone more slowly, carefully raising number of cells that take away old bone and raising the number of cells that replace the fissured bone with new strong an integrated bone, in the same way that our bodies replace bone until the balance of cells that dissolve the weakened bone exceed the cells that replace bone. Most markedly at menopause.
Evenity blocks the cells that breakdown bone by depriving them of sclerostin. Evenity adds bone faster than any of the other medications for six months. While that bone is lost the fastest of any medication except Prolia, my thought (objection) is because it is deposited on an unstable surface, it isn't the best bone. With Evenity, Prolia and the bisphosphonates you end up with bone that is less vascular, more brittle, less able to withstand pressure. The loss of vascularity is why antiresorptives and Evenity ( which I ,alone, consider an antiresorptive) incur the risk of osteonecrosis, and atypical femur fractures.
But look consider Evenity because you have the preference. It is an amazing medication for someone who is on the verge of fractures and needs immediate reinforcement. You may fear imminent fracture with a -3.9. You've had one fracture and certainly need to avoid another. If you do decide on Evenity, ask your endocrinologist if you could use it for 6 months. Find out what she would be willing to prescribe following Evenity. Individuals are having success at following Evenity with Tymlos or Forteo, but I don't think it is mainstream, yet. I say six months of Evenity because in the first six months you gain the most bone. Then the drug becomes less effective as the body finds a way to replace sclerostin.
As an aside, I suspect your healed fracture was caused by Prolia rebound. You did the best thing in taking Reclast, but Reclast sometimes just isn't enough to counteract the penalties of coming off ten years of Prolia. During those ten years Prolia may have protected you from many more fractures than it finally causes. There is no way to know.
Someone on site is waving the ten years safety flag for Prolia. There is no accounting for the over half of participants who quit the medication. And vertebral fracture aren't counted anyway.
You might ask for bone markers CTX and P1NP before starting any medication for osteoporosis
I hope you get more answers and ask more questions.
Bless your choice, bless your bones.