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

Hi @pauladiamante, when was the CTX result (285) taken? If that was your baseline before any treatment, then your bone resorption is on the lower side. But if it was measured while you're on Evenity, that would sense since evenity suppresses bone resorption, so this CTX reading is expected.

I've read that for people with very low baseline bone turnover, some endos may choose to use a lower dose (I've come across 1/2 dose of fosamax - 35mg/wkly) of bisphosphonate to help "lock-in" the bmd gains after an anabolic treatment. So basically some form of antiresorptive therapy is still needed after an anabolic even if your true baseline CTX is very low. In this case, you could taper off the antiresorptive therapy over time with careful monitoring.

That said, oral form of bisphosphonates such as fosamax or actonel are usually easier to adjust in terms of dosing. Smaller dose of iv zolendronate is an alternative. Personally, I don't see how you could taper off Prolia without transitioning to a bisphosphonate, unless you've only had one dose. Even then, your resorption ( as indicated by CTX) is likely to go up once that dose wears off, then returns to your baseline after a period of time. You may or maynot have some degree of bone loss during this period.

Thanks. So much food for thought!!! I never had a baseline CTX pre evenity. This is my 1st one. I completed a year of evenity about 3 months ago.

@gently and @pauladiamante and @dbamos1945
Please listen to this podcast where Margie Bissinger interviewed Dr Keith McCormick.

Please listen to this podcast where Dr Keith McCormick (author of Great Bones, an “encyclopedia” about Osteoporosis) talks about all the OP medicines.

I will listen, Thanks very much. I guess my confusion is that I do not really understand why I should have to be on anything at all, if the tumors that caused the bone destruction have been removed, and if the evenity has replenished bone adequately, why would I continue to lose bone? Why do I need another drug? I haven't heard anyone explain that to me yet. Why am I not "cured"? Maybe They are saying Evenity did not do an adequate job? I'll listen. Thanks

Thank you. I listened to good bones podcast. It was helpful

Okay everyone. Thank you. You ha e directed me to all the right reading material and I finally UNDERSTAND. There is NOTHONG wrong, weak, superficial or temporary with the bone I gained taking evenity.
The reason people lose evenity bone is because their bodies reset to the pre-medication breakdown process.
My premedocation breakdown process was due to the hormone that my tumors produced. The tumors are removed. I should not have an excessive amount of bone resorption.
We don't know what my "normal" would be without drugs.
I workout pretty hard. 5 or 6 days a week. It would be wrong for me to suppress bone remodeling.
I'm willing to give my body a chance for at least a year off meds to see where it settles in its own natural state.
I appreciate all your contributions to my learning!!
Thank you!

Your reasoning sounds logical but at this point you have no idea if your bone metabolism is normal even after the surgery. Your CTX isn't exactly low so you have some bone breakdown going on. Estrogen also plays a role so if you are on HRT, that is another factor that could help you retain the bone you built on Evenity. At 70, you may also have age-related bone metabolism changes that will prevent you from retaining bone.

I think your doctor is being reasonable in recommending a short course of another medication to prevent additional bone loss. It's not a given that everyone loses bone after Evenity but some do so the protocol is to follow it up with a bisphosphonate or denosumab as a risk reduction strategy.

As an MD, do you have access to other sources of information? This is a laymen's site and no one here is an endocrinologist or rheumatologist specializing in osteoporosis. If it's an option to get more opinions from your peers, especially ones that treat osteoporosis, then I think that might be a good direction to go.

For reference, I am a former RN who's had osteopenia/osteoporosis for 11 years (starting at age 53). I fractured while on a bisphosphonate, HRT, strength training, good diet, etc. I am on Evenity now. By no means am I an expert beyond what I've learned through my diagnosis and treatment. My parathyroid levels have always been normal. My only risk factors were family history (my dad had severe osteoporosis) and age.

I resonated with oopsiedaisy's opinion. If there is no follow-up therapy after Evenity, future bone turnover will rely on your body's natural balance between resorption and formation.

With the secondary cause of bone loss addressed (removal of the parathyroid tumor, and assuming your bone remodeling has reset to pre-hyperparathyroidism levels), the primary cause, estrogen deficiency, still remains.

Many postmenopausal women in their 70s may see a natural slowing of bone resorption, which might be helpful. However, a gradual decline in bone formation is almost inevitable with age unfortunately. The balance between these two opposing processes may not always support a healthy bone turnover or maintenance.

Personally, i'd lean toward a short-term course of an antiresorptive, with close monitoring of bone turnover markers as you transition off medication if you could. Even a low dose of estrogen could be considered (full disclosure - I'm a bit biased, as I'm currently using it myself after Forteo). Unlike bisphosphonates though, it does need to be taken continuously to maintain its benefits.

Please keep us posted on your journey if you can. Wishing you continued good health and all the best on your bone health journey.

Thanks so much for your thoughtful reply. You make some good points.
I will continue to keep an open mind to options.
I WOULD like to know what my body will do on its own. .. I will discuss this with my endocrinologist. But to be completely candid. The reason I'm here discussing it with all of you is that I don't have an endocrinologist that I trust! They are accustomed to recipients of care. I require a physician that can see me as a participant in my health care. If you know someone clue me in!
I have access to plenty of Medical journals and research... and after quite a bit of searching and reading I discovered the issue is that there has not been any trials with patients in my situation. Like I said.
No charts fit my history. We don't know what my bone health will be off medication We do not have a baseline to anticipate returning to.
Thanks again for reaching out.