The Doctors Reply after Prolia AFF and now recommends Forteo

Posted by sbax75 @sbax75, Oct 23 3:57pm

Your thoughts are appreciated: On Prolia six years: Three weeks ago I had a A-typical fracture. After the fracture, I suggested Reclast to my endocrinologist, after she wanted me to go on Tymlos. Insurance denied that and now she wants me on Forteo. This is what she replied to my question:
" "The reason why I didn't want to go with Reclast is that it is a bisphosphonate, which carries the highest risk of atypical femur fractures. Ongoing exposure to bisphosphonates only put you at higher risk of fracture of your other femur.
Yes, typically reclast/bisphosphonates are recommended after Prolia, but not in cases of atypical femur fracture unless both femurs were surgically operated on and fixed." " Does what this Doctor writes above make sense?
Please share your insights into next steps.

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windyshores | @windyshores | 18 hours ago

In reply to @gently "Would you consider combination therapy? with or without bone markers?" + (show)

@gently I mainly rely on Dr/ Ben Leder's video on Combination and Sequential Approaches to Osteoporosis as well as McCormick's "Great Bones."

Leder says combining Forteo and Prolia has dramatic effects. Forteo first (for 9 months as I remember) with Prolia coming on and intersecting. His video says that combining Forteo with a bisphosphonate does not improve over either alone.

All the sources I have seen say that Forteo and Tymlos are ineffective after Prolia and should not be considered.

Leder's videos have a lot of graphs and charts that make all this visually clear. I am relying on memory so check them out. He is a leading MD and researcher at Mass. General in Boston. He is also on OsteoBoston on You Tube.

These positions conflict with those in the study posted by @gently. Here is the conclusion in that:
"It is clearly time to re-evaluate the potential benefits of combination therapy, with a careful attention to effects on both spine and hip. In patients who have previously received bisphosphonate agents, there is no question that different results are achieved at the hip and perhaps other sites rich in cortical bone with combination vs individual therapy. The current study by Walker et al. adds to the growing literature that suggests that even in patients who have not been on bisphosphonate treatment previously, a superior hip BMD response might also be achieved with combination therapy (in this case, teriparatide plus risedronate). These differences might be clinically meaningful, particularly for patients at highest risk for hip fractures, including those who have had a recent hip fracture, multiple prevalent fractures, or extremely low hip BMD."

This clearly challenges the oft cited idea that bisphosphonates reduce effectiveness of anabolics.

smg22 | @smg22 | 16 hours ago

In reply to @windyshores "@smg22 I have read and heard that Forteo is ineffective after Prolia. McCormick's book "Great Bones"..." + (show)

@windyshores - thank you and my (new) doctor's reasoning was that due to the sudden & intense jaw pain that I experienced 1-week after my last Prolia shot back in June 2024, he was reluctant to put me on a Bisphosphonate due to potential risks for further issues (osteonecrosis); as they too can cause it. I did ask him for Reclast (I was on that prior to Prolia), and he said it's the strongest of the Bisphosphonates and said no to it. If my insurance denies Forteo, then he will put me on Fosamax.