Prolia then Reclast

@followheart87 I have the same question. I am Asian and small-boned. In spite of osteopenia-level DXA readings for about 3 years, my PCP never prescribed anything beyond Calcium, B12 and D3. This year, my lower spine reading hit 3 and she wants me to go on Prolia. All of the other readings are still in the normal or osteopenia-level, so I am wondering why the sudden dive in at the deep end? Her argument is that stress fractures are very painful, but no one in my family has had a stress fracture. I am in my mid-70s and from what I have read/learned from Mayo videos about Prolia, it cannot be taken long-term and has to be tapered off carefully with Reclast. One patient had experienced the side effect of receding gums but my doctor didn't think that was a problem! But why start Prolia at all?

This is a great question and I am eager for some clarity. My doctor just recommended this because of hesitation with Evenity for the black box warnings I might be at risk for with family heart history and my own insomnia. Right now it all appears to be an endless loop of managing life altering side effects. Frustrating to say the least.

I’ve been on Prolia for two years. My rheumatologist never told me it was a drug I would not be able to stop unless I transitioned to another similar drug. So here we are. I share the frustration with hundreds of women out there. It’s my understanding that Prolia builds bone and Reclast maintains the bone. But I could be wrong. I believe the plan for me is to stay on Prolia for several years and then transition to a medication that maintains the bone. Right now I feel like I am walking a tightrope without a net. This is because I had an extraction and implant that needs to heal for at least 3 to 4 months and my oral surgeon and my rheumatologist have differing opinions as to when I should start back on the Prolia.

I am on my last few months of Evenity and I am so stressed over Prolia and Reclast. So many side effects and your right...I dont feel like the doctors tell everything. I read Prolia can cause major jaw issues and Reclast esophagus issues.

@lioness2001 Responding to "It’s my understanding that Prolia builds bone and Reclast maintains the bone." Not quite. Check the Prolia website page on how Prolia works.
Denosumab will "stop the development of bone-removing cells" which is why when we go off it, there is a rush of bone-removing cell growth and we risk stress fracture. I check their website frequently and there are always new warnings. I don't think there are definitive answers yet.

@joyceh2025

Saw the date on this but have to ask why they did not consider an anabolic.

Prolia is better at enabling you to continue to build bone after Evenity. This is because it suppresses the development of osteoclasts (bone breakdown cells) rather than just killing off your osteoclasts which is what Reclast does. Apparently you end up with fewer mature osteoclasts destroying bone if you are on Prolia.

This lets your osteoblasts (bone building cells) continue to grow new bone without the osteoclasts coming in and destroying more bone that you build.

The problem is that Prolia holds the development of the osteoclast cell in an immature state so when you stop it suddenly, all of those cells continue on to maturity and go to work destroying bone. This can result in a cascade of vertebral fractures unless you take Reclast (or another bisphosphonate) to kill off those newly matured osteoclasts.

I am nearing the end of my Evenity treatment and my endocrinologist will make a recommendation based on my BMD improvement. If I've moved into osteopenia then she will recommend Reclast. If I am still in osteoporosis she is going to recommend Prolia. It won't matter either way to me as I will not be going on Prolia at this point and will choose to do Reclast.

If I fracture again or my BMD decreases sharply over the next few years, I may consider Prolia at that point.

@gravity3 I'm not sure what you mean by "anabolic." Can you explain, please?

@joyceh2025

Anabolic meds for osteoporosis. Forteo, tymlos and evenity. They are considered to be bone builders. Anti resorptive meds are Drugs that slow bone loss. Simplistic explanation but there is plenty to help you research.
Sequencing is important in treatment with osteoporosis drugs. Make sure you do your own research so that you can have a well informed discussion with your provider about your treatment plan.

In answer to the question "why not just go on Reclast first? Why go on Prolia at all? " -- I can only say that my doctor (endocrinologist) prescribed Reclast because my insurance company does not cover Prolia. I'm 82, I have untreated osteoporosis, and have avoided medications so far. Maybe your doctor has a particular reason for this strategy. I think that one of these meds inhibits bone-destruction, and the other boosts bone-building. But I'm not sure which is which. good luck!