Thanx for the UTube cites. I have a high regard for Cleveland CLinic, but have no idea who this other guy might be. In any event, my own preference for learning is the written word.....I do not absorb info as well when it is given in lecture form. And especially when it is in science-speak.

Nonetheless, these videos have given me some ideas about discussing whether to continue or stop the Alendronate after one year when I see my doctor about it next May.

I too failed to do sufficient research about Prolia before beginning it. I am retired and travel a lot....precise timing of Prolia injection was my biggest concern initially and for that reason alone, Prolia was not a good fit. Of course I was not told anything about the need for exit strategies which would likely have made me more hesitant to start it. Nor told that my DEXA score might not even be low enough to warrant Prolia or that bone-building meds might also be an option...the doctor was simply concerned with how long I had been on Alendronate, never mentioning a possible drug holiday because my DEXA scan put me into osteoporosis territory, (FYI: the doctor who first prescribed Alendronate was a very good doctor of mine for 25 years....my understanding is that he hoped to keep me from slipping into OP after my ovarian cancer treatment eliminated any sliver of natural estrogen production.)

In retrospect, I personally feel that the Prolia recommendation may have been driven by insurance guidelines more than by good medicine. Are you Medicare eligible?

I had no side effects with either Prolia or Alendronate, either pre-Prolia or post.

I hope there is a typo in your post about taking only 2 oz of water after the alendronate. The instructions that came with my meds direct 8oz of water before the med and another 8oz after the med. That may be difficult for some people but not for me as I am familiar with hydrating because I play tennis primarily in hot weather.

As to your concern about the present usefulness of BTM tests if there is no baseline, I too have never had either of these tests. However, there is a reference in the NIH survey material that a European medical society recommends absolute values for both CTX and PNIP in determining 'adequate response' to whatever post-Prolia med is taken.

I will certainly also be taking this up with my doctor in May....of course there was also never any mention about these tests in determining possible treatment options.

You seem very concerned about your situation because you took 3 Prolia injections before transitioning to alendronate at the time when the 4th Prolia was due. I do not see how that is so different from my situation after only 2 Prolia injections. It seems that Prolia's effectiveness is not cumulative and that that is why there is not a lot of flexibility about the timing of each injection. Or am I missing something?