The main issue with Prolia, in the absence of side effects, is that it is very hard to get off. If you stop or even miss a dose, bone density can plummet and fracture risk rise substantially, according to my doc and also McCormick's recent well-regarded book "Great Bones." If you do stop at some point, the timing of transition to Reclast or Fosamax needs to be individualized using blood tests *CTX, and P1NP may also be helpful).