High anxiety regarding Reclast or Prolia decison for OP meds
I am overwhelmed with making this decision. Currently on Evenity, 2 more injections left. Severe Osteporosis. Spine -4.7. I left my OP Dr's office last week with an order for Prolia starting Oct/Nov. And blood work orders. We did discuss Prolia vs Reclast but I didn't ask enough questions I guess, despite having a 1 hour appt with her. I did know and told her I feared Prolia. She relayed how much easier it was than Reclast. And the Reclast stays in your system much longer. She wrote the RX for Prolia for 1 year, then relay to Evenity again. That does not sound right to me. I can't find any studies supporting that drug sequencing. This Dr is new to me but in the practice of the most respected Endo offices in my state. She only see OP patients. I am staying up til 3am every night reading and researching. There is no right answer.
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I'd like to see that.
So in that case would the Reclast be given for 1 year? Or longer after the 1 yr of Evenity?
Can you take Tymlos after Evenity? I had Forteo before the Evenity.
@255anny, the same cautions about Forteo would apply to Tymlos.
Did you have density gain with Forteo?
@25anny how long you would take Reclast after Evenity depends on your DEXA and your bone markers. My docs expect me to do it for three years but I doubt I will. The limit is 5 years, not sure if that is for a lifetime or one course. Most people are able to take a drug holiday. Some docs do it every 2 years.
There is no data, according to my doctors, on Evenity after Forteo or Tymlos, let alone on the other way around. I was originally told, I think in a masterclass on osteoporosis, that you could do Tymlos or Forteo first but not Evenity, possibly because Evenity "turbocharges" growth (I remember that word being used) so there is less for the other meds to do. But Evenity came out in 2019, that was early 2021, so I don't know what has come out since. My doctors are very "evidence-based" and are waiting for studies so Reclast is all they discuss right now. I am going to bring up doing more anabolics.
I don't think there are any definite answers right now. It's helpful that we all research (and share it) but in practice the choice right now are limited: seems to be Prolia or Reclast after Evenity and if Prolia is done, many people are doing one year and then doing Reclast. Even that latter strategy is relatively new, at least for me. I am doing lower dose Reclast more often so am in your same position of wondering what to do next.
Yes, apparently there is a shortage of Endo's. My GI Dr and I were discussing my Osteoporosis. He knew my new Endo Dr and remarked that she was very fortunate to get the position she got, due to so many applicants. A few years ago, my then Endo Dr mentioned most Endo Dr's are not it the field for the big bucks!
Thank you, I really appreciate the help. Just when I think I've got a loose grip on understanding these drugs, I get sidetracked by reading something else and lose all direction!
Since my bones scores are so low, -4.7, it seems to me it would take forever for any drug to bring those scores to an acceptable level. But what is an acceptable score for me? It's so complicated.
At some point won't I have to just say ok this is what it is and live my best life?! If I took Reclast for 1 or 2 years, the hopes would be that I can hold on to the pathetic gains I got from this past year of Evenity. But the Prolia would probably give me a bigger boost - but with risk factors I'm not sure I want to live with. I've read many times over that we shouldn't focus on just our T-scores, look at the big picture. Well, my TBS scoring puts me borderline ok. My diet these past few years has no doubt contributed to my bone loss. I have really increased my calcium and protein daily now that I can tolerate more foods. So maybe, fingers crossed, that will help.
I remember my now retired Endo saying the Evenity he was putting me on was "bringing out the big guns"! My initial OP drug was Forteo and I failed to get any gains, so hence the Evenity.
I would not mind going back on Forteo or Tymlos, though I dreaded those dang daily shots. I hated doing that. But would one of those help, who knows. Isn't Tymlos stronger than Forteo?
I know we have all been told don't read all the negative things you see on social media about these drugs. But holy cow, those posts are scary. But I still want to know, good or bad.
No gains with Forteo. But looking back at those 2 years, I was in the middle of SIBO and Diverticulitis flare ups. So my diet and nutrition was horrible. I'm sure that made a negative impact.
We refer to relay drugs as the one you take next. Current thinking has us taking one drug after another sometimes cycling back to the first.
But in the wider scientific world, genetic and computational advances locate genetic mutations and use silico (computational models and simulation) to develope experimental medications called relay drugs.
It seems that for effective Forteo one has to be absorbing calcium. If you did return to Forteo or divert to Tymlos, be sure and have bone markers before and after one to two months. One advantage with these anabolics is that the jump in bone building starts quickly, so the bone markers could let you know if you should yield to a different medication.
Just want to clarify that the following statement in my response reflects what I have been told by doctors and should be confirmed by your own doctor! "@25anny how long you would take Reclast after Evenity depends on your DEXA and your bone markers. "
Too late to edit!