Reclast vs Prolia question

Most studies don’t give rebound fracture rates based on how many Prolia injections someone has had. That said, case reports show that stopping Prolia isn’t completely risk-free, even if treatment lasted less than two years. Factors that increase risk include longer duration of therapy, high baseline fracture risk, low bone density when stopping, and a history of multiple fractures, etc.

Just to clarify, is this your first osteoporosis medication, or a follow-up (relay) from an earlier one?

@mayblin this is my first as had a bad GI reaction to one alendronate pill which I have stopped. And still affecting me (reflux) at night 4 weeks later. Food and Gaviscon helps that.
I’ve resisted meds (since 2001) til now but after 2 recent vertebral fractures am probably wise to start. I’m 77. Fracture risk was 25% in 2019.
From -3.8 and -1.5 in 2001 to -4.5 and 2.2 in 2025. (Covid restrictions and a car accident and 2 falls in 2024 all took their toll. (I got over the fractures much faster than the reaction to the Alendronate! )
I’m seeing the same specialist in November from 2001 snd 2019 so not sure what he will recommend this time. I’m also wanting to see how the relay would be done.
I would prefer the anabolic but not sure if I qualify. (In Canada)
But a relay is needed for Forteo too is that right?
Thanks for replying. It is so helpful to get thoughts from those with more experience.

@brendammc I’m sorry to hear about the fractures you sustained - I hope you’re recovering well.

With two recent vertebral fractures and a T-score of -4.5, you would almost certainly qualify for an anabolic such as Forteo (or biosimilar teriparatide) and possibly also Evenity (romosozumab), which is often prioritized in people at very high fracture risk, especially with recent vertebral fractures. Here in the U.S., doctors usually submit a prior authorization if insurance initially denies coverage, though I’m not sure how the process works in Canada. Both drugs are strong bone-building options, though Evenity isn’t recommended for people with significant cardiovascular risk.

I think it’s important to consider getting a baseline bone turnover marker before starting therapy. That gives a snapshot of your bone metabolism. If turnover is very low, your endocrinologist might later adjust follow-up treatment - for example, zolendronate (Reclast, or Aclasta, or Zometa) dosing or dosing interval can sometimes be modified, while Prolia is always given at a fixed dose.

Regardless of which anabolic you start, you’ll still need to transition to an antiresorptive afterward to preserve the gains. Reclast is often the simpler “exit” option, while Prolia could continue to increase bmd but requires a careful discontinuation plan to avoid rebound bone loss in the event that you need to stop using it.

I’ve personally used Forteo and HRT, and I’ve spent a lot of time reading about osteoporosis treatments. Just thought I’d share what I’ve learned, in case any of it helps in your conversations with your doctor.

All the best to you! Please keep us updated on which medication you and your doctor decide on.

@mayblin this is my first as had a bad GI reaction to one alendronate pill which I have stopped. And still affecting me (reflux) at night 4 weeks later. Food and Gaviscon helps that.
I’ve resisted meds (since 2001) til now but after 2 recent vertebral fractures am probably wise to start. I’m 77. Fracture risk was 25% in 2019.
From -3.8 and -1.5 in 2001 to -4.5 and 2.2 in 2025. (Covid restrictions and a car accident and 2 falls in 2024 all took their toll. (I got over the fractures much faster than the reaction to the Alendronate! )
I’m seeing the same specialist in November from 2001 snd 2019 so not sure what he will recommend this time. I’m also wanting to see how the relay would be done.
I would prefer the anabolic but not sure if I qualify. (In Canada)
But a relay is needed for Forteo too is that right?
Thanks for replying. It is so helpful to get thoughts from those with more experience.

@brendammc I live in Canada and have been on Forteo twice now. I also had a severe reaction to bisophonates and as it turns out, anabolic works better if you have not taken them, so glad it worked out that way. I would not do Prolia as first line treatment.