Do I need to start Prolia? or can I wait and follow my lab results to

pauladiamante, you'll be wise to take a follow-up medication after Evenity. And wiser still if you decline Prolia,
in my (not very) humble opinion. Without another medication you will lose any gain from Evenity within one year. Your doctor probably recommends Prolia because Amgen recommends that you stay on their medications.
Their reason is profit, but your doctor? I don't know. Could be the massive campaign directed toward doctors has affected his thinking.
I'd wait for the dexa results and ask for a CTX and P1NP. I'd be trying to get a earlier dexa if I'd completed 6 months from the injection.
Prolia would take your CTX down to around 50, which has a good and a bad story to tell.
CTX stands in as a measurement for osteoclasts Osteoclasts break down damaged bone. Prolia builds bone over bone that is breaking down. It collects the fissured bones and the unformed osteoclasts. Because it collects less stable bone, you have a risk of fractur and/or decay in that bone. Because it collects the osteoblasts, if you ever stop the drug you are likely to experience multiple fractures, (cascades they call them), unless you take a strong medication to block and destroy those osteoclasts.
You'll field differing opinions, so listen carefully, and question everything.

@gently: I’m very interested in your bone building theory or should I call it osteoporosis prescription to avoid Prolia recommendations?!?
I think i am convinced, but a little confused on what drug to put in my body to help my bones retain strength gained by Evenity. I am 80 yr old female ready to take my 4th month injections of Evenity. I took Risedronate for 3 1/2 yrs prior to repeated DEXA scan that showed increased bone loss in Lumbar Spine and Hips - so Dr suggested Evenity. Is Forteo or Tymlos the best follow-up drug or would you recommend another osteoporosis treatment? For how long to take it? What’s next choice of drugs that follow it? What is your opinion of taking drug holidays & for how many years between treatment? I am needing your expert advice.
Thank you. Please Reply to dbamos1945.

@gently Thank you. I am still confused about the need for continued medication. This is not postmenopausal osteoporosis. It is due to hyperparathyroid syndrome, and the tumors have been removed, therefor the root cause of bone degeneration should be eliminated. At least that is what I think.
My Dexa is in 5 days. Aug. 22. Not too far.
If it is indeed justifiable for a reason that I am not clear about, to take another medication what do you think is better?
Thanks for the info on AMGEN products. I didn't know that. I completely get it about prolia. I really don't want to go down that road.

@pauladiamante, I cannot take Evenity because I have a heart condition, and that drug carries a black box cardiac warning. However, there is controversy as to whether there really is a heart attack/stroke risk with Evenity. I just finished 2 years on Tymlos, have severe osteoporosis and had to choose my next drug. The choice was Prolia or Reclast. I have researched both, and am unhappy with both, but I have been told by 2 physicians that you can get 1 or 2 Prolia injections and then quit without risking the vertebral fracture cascade; that seems to happen when you stay on Prolia longer. In my case, the Prolia will likely do a better job for me than the Reclast, and if I have bad side effects or an adverse "event," the drug is only in my body for 6 or so months, whereas Reclast is an annual shot. So I am going to risk a shot or two and hope for more clarity re: Evenity in this coming year. I have heard of other people briefly using Prolia to buy time, and maybe that would work somewhat for you.

Thank you very much for this. Yes I do know about the black box label for cardiac issues and evenity .
This is exactly what my Dr was recommending actually he said 2 doses of prolia. And I would not be staying on it longer according to him.
So you've given me some confidence about taking his advice. I truly appreciate your inputI

Just to let you know there is some misinformation here above. Evenity is not a bisphosphate. Does not work the same way as prolia.
Thanks.

I was put on prolia 10 years ago by my endocrinologist. I have now suffered an atypical stress fracture of the femur caused by prolia. Getting off Prolia after such a long time has a dire outlook of further fractures. I don’t know where to turn as the endocrinologist only lists the other drugs already discussed in this feed. Anything else that anyone can suggest? I have two months until the Prolia in my system is depleted.

pauladiamante,
you really do have to question everything. Some women never need osteoporosis meds, others untreated never fracture. Your next dexa won't tell you, though. Even if your numbers are greatly improved, Evenity bone is gradually lost over a year after treatment (but maybe not your Evenity bone). A dexa in six months would give you clues, a dexa in a year might be a late. I'm happy Prolia is out. You will probably be offered one of the bisphosphonates. I'd plead for Forteo. Forteo isn't a usual sequence after Evenity, but thanks to the generosity of some of the posters here (thanks, hollygs) it is looking like an effective drug to follow Evenity.
If we are slowing down, as we are supposed to in age, the antiresorptives are a strong choice. But most of us are not behaving that way.

dbamos1945, good title for my musings. But remember that some people fare well on Prolia, some without any side effects and big thick strong bones.
I can't be the expert. I've no medical background and almost no experience with the medications. I just like to tell people what to do.
Evenity is so much easier to take than the daily injectables. I am glad you transitioned from risedronate. How low were your numbers. If they were very low cheers to your endocrinologist. Evenity might be the very best to prevent imminent fracture.
I wish you were having bone markers, at least P1NP because Evenity doesn't work for some few. No matter the P1NP, you've gotten the best bone growth from Evenity after the 3rd or 4th injection. I (personally) would switch at the month mark after the fourth injection to Forteo or Tymlos.
My musings have a subtitle so we have "Osteoporosis prescription to avoid Prolia : How to get home safely with an anabolic."
Some though, can't tolerate Forteo. Some few also have taken a year of Tymlos without gaining bone.
I can't say that the usual antiresorptive is a good choice after Evenity, because it doesn't make sense to me to follow a drug that ends primarily antiresorptive with another antiresorptive.
But your question makes me realize that there must be a chart with Evenity followed by a bisphosphonate.
You can trust my intentions, but all theories from everyone must be treated with suspicion.

A chart is good for that specific info. I agree. Bisphosphonate following Evenety.. my question is for a specific issue. It's the cause of the osteoporosis has been treated. Tumors were removed Jan 2024 that were tearing up my bones. So I figure, if the evenety did its job I shouldn't be in any worse shape than any other healthy person in my age group.... I mean I'm pretty active, I work out. Weight lifting.. wild animal rehab ... I still can't figure out why I need to be medicated. Regardless of the medications mechanism of action. I AM an MD. But not an endocrinologist. And I have a hard time trusting opinion....