Sudden drop of BMD while on Prolia.

@connectalant I posted in another thread on how switching to Tymlos of Forteo if you have been on Prolia more than 1-2 years is not a good idea, based on Great Bones" by Keith McCormick (page 569) and the excellent YouTube by Dr. Ben Leder on Combining and Sequential Approaches to Osteoporosis (minute 35 as I remember). Not only is this switch not effective, according to them, but it can make things worse. These resources and my own doctors say that Reclast is the only med that can avoid the rebound, or possibly to a lesser extent, Fosamax. Or you could stay on Prolia for longer-?

I have read the study by Dr. Leder and agree with you. (I will also check the additional references provided by you). My initial thought was to remain on Prolia and to go to Reclast if future DexaScans indicate a further decline in BMD.

The original reason to use Prolia was replace the use of bisphosphonates (after a long drug holiday), which permitted correction of recurring dental problems at 6 month intervals. I am a devoted follower of Dr. Robert Marx. It was not until much later I found that Prolia was a "lifetime" drug. I have been at a high fracture risk level for many years, fortunately with no problems. Going to Forteo or Tymlos and returning to Prolia after two years seemed to be the ideal solution. Finding Dr. Leder's study, however, indicates this would indeed be a poor choice. Unfortunately, there seems to be no perfect solution.

@connectalant I wonder if you could do Reclast for a year and then do Forteo, Tymlos or Evenity. I don't know, but it's a thought and seems like it might be possible- once the rebound is prevented by the Reclast.

Sorry for delay in responding. Had to reset password. Do no know if I will still show as connectalant.

I have read elsewhere that going to Prolia to Reclast has the same risk rebound risk as Prolia to Forteo.

Still worth considering. But Prolia to Reclast for one year then to Forteo for two years would then require another change to Prolia?

@connectalant I posted in another thread on how switching to Tymlos of Forteo if you have been on Prolia more than 1-2 years is not a good idea, based on Great Bones" by Keith McCormick (page 569) and the excellent YouTube by Dr. Ben Leder on Combining and Sequential Approaches to Osteoporosis (minute 35 as I remember). Not only is this switch not effective, according to them, but it can make things worse. These resources and my own doctors say that Reclast is the only med that can avoid the rebound, or possibly to a lesser extent, Fosamax. Or you could stay on Prolia for longer-?

I have not read or been told by anyone that Prolia to Reclast has the same risk rebound as Prolia to Forteo, and have seen in Ben Leder's video on You Tube and Keith McCormick's book "Great Bones" that Forteo is not especially effective after Prolia. You absolutely need to do Reclast. I have been told/read/seen that only Reclast is strong enough to avoid rebound, though aldendronate can be used if you cannot tolerate Reclast.

If you then did Forteo (and the effectiveness would be somewhat less at that point) you would follow with Reclast, not Prolia. Another option would be Evenity between the Reclast treatments. In fact there is a current study on doing 6 months of Evenity, not 12, between other osteoporosis meds- because the first 6 months are bone building and the second 6 months is anti-resorptive like Reclast.

I have not read or been told by anyone that Prolia to Reclast has the same risk rebound as Prolia to Forteo, and have seen in Ben Leder's video on You Tube and Keith McCormick's book "Great Bones" that Forteo is not especially effective after Prolia. You absolutely need to do Reclast. I have been told/read/seen that only Reclast is strong enough to avoid rebound, though aldendronate can be used if you cannot tolerate Reclast.

If you then did Forteo (and the effectiveness would be somewhat less at that point) you would follow with Reclast, not Prolia. Another option would be Evenity between the Reclast treatments. In fact there is a current study on doing 6 months of Evenity, not 12, between other osteoporosis meds- because the first 6 months are bone building and the second 6 months is anti-resorptive like Reclast.

Authors were Kadaru and Shibli-Rahher.

Can you share the link? The results need to be compared with bone loss on any other follow up. The study needs to state how long the participants were on Prolia and how long a break there was between Prolia and Reclast etc. I would love to see it.

ncbi/nlm/nih.gov/pmc/articles/PMC7973401

Please let me have your thoughts.

I did see an Endo at a major teaching hospital. Recommendation was to remain on Prolia as long as possible (subject to periodic testing), then go Reclast, ultimately going back to Prolia. This made sense to me. FYI - I am 81+ years old, but otherwise reasonable healthy. I went to the hospital since I was unable to understand how a 12% drop could occur.

I then located a local (within 50 miles) Endo (with a specialty in osteoporosis) to treat me and monitor my progress. He impressed me with his thoroughness. His course of treatment was to go off Prolia (anytime soon) to Forteo and after 24 months back to Prolia. With my ongoing dental problems it sounded like a miracle. Until my research identified the rebound problem.

I have had 2 MRI's, one locally indicating an 12% bmd drop in my hip over a two year period and about the same drop as over past six years. A retest showed a 9% drop. An MRI at the hospital, however, showed an improvement of 3% over nearly the same 6 year period. Since being on Prolia (accordingly to my "local" DexaScan) the BMD of the neck has not changed, while the total hip actually decreased 10%. I JUST TOOK ANOTHER LOOK AT MY DEXASCAN HISTORY AND INCLUDED THIS PARAGRAPH FOR MY BENEFIT. I think I just ratified my decision to stay on Prolia. It does make we wonder if I am already back to my Prolia baseline.