prolia vs forteo

Forteo and Tymlos are similar. I chose Tymlos because the dose is adjustable and I could ramp up and then stay at a level I could tolerate (eventually 7/8 dose). My docs don't use Prolia unless absolutely necessary because it is so difficult to get off without increased fracture risk. If you can tolerate Forteo that is a good option too. With a fracture, insurance should cover these options.

I chose Forteo, but would have chosen Tymlos if I'd met windyshores a little earlier.
Forteo is a wonderful drug for me, no side effects. The injection is so simple, the needle so tiny. If you have side effects, you can just quit.
I wouldn't take Prolia. (Well, I might if I were desperate.) It works by supressing the cells that destroy bones. But those cell wait in a "pool" (they call it), until you stop the drug or are late for the injection. Then they besiege your bones. So you have to follow quickly with another pharmaceutical to prevent fracture.
best luck with your choice

@gently appreciated the explanation about the "pool." Noone has explained the sudden drop in bone density and increase in fracture risk after stopping Prolia!

Keith McCormick's book "Great Bones" has a section on the difficulties and risks while transitioning from Prolia to Reclast. The timing needs to be individualized based on blood tests (CTX).

@gently so glad you tolerate Forteo! If I had been able to, I would have done it 10 years ago and avoided the 2021 fractures. Tymlos is better late than never! Did my first Evenity this week.

What is the doc's rationale?

gravity3,
doctors who prescribed Prolia when it was approved in 2011 before the mechanisms of action were completely delineated are reluctant to prescribe Prolia now. Many had patients who lost so much bone with cessation of the drug that they experienced multiple thoracic fractures. It was at the expense of those women's health that new guidlines were recognized. The hail is "You can never quit Prolia," though you can successfully transition.
One woman with osteopenia, she didn't even have osteoporosis, had seven column fractures when she was late for her injections because of Covid.
I'm not answering for donnac's doctor, but I don't like the mechanism of action of Prolia or the Bisphosphonates. They prevent bone remodeling. So they save the older bone with all its tendency to fissure and with its inability to repair itself properly and no ability to renew itself. Still, these drugs have prevented far more fractures than they have facilitated in the overall picture.

Apparently they have changed the way they diagnose Osteoporosis. I had a wrist fracture and an elbow fracture from a fall post-menopause and I fit the physical criteria, small, caucasian etc. Currently, I don’t take any medication so reluctant to start but I suppose the pros of taking outweigh the risks.

Were your falls considered traumatic @donnac2360? You don't have to reveal but curious what your DEXA scores were. It is true that some docs prescribe too early. If your fall was traumatic and DEXA isn't too bad, maybe do a consultation with Dr. Keith McCormick for an alternative viewpoint. He is good with "whole body" approaches but also suggests meds when needed.

If you do need meds, it is now suggested to do a bone builder first- Tymlos, Forteo or Evenity- and then "lock in" with a bisphosphonate, preferably Reclast. Insurance should cover you because of the fractures.

I had fractures from a fall and did not go on med for 14 years. (I did actually try.) I finally had osteoporotic fractures from an extremely unwise movement. My point is you probably have time to think about this and explore options. Definitely get other opinions!