Transitioning from Prolia to Estrogen

When managing osteoporosis, transitioning between treatments is a crucial aspect of maintaining bone health. Prolia (denosumab) is often prescribed to prevent bone resorption and increase bone density, but there may come a time when transitioning to estrogen therapy becomes necessary. This guide outlines the reasons for such a transition, the potential risks, and the steps to ensure a smooth and safe change.

Why Transition from Prolia to Estrogen?

There are several reasons to consider transitioning from Prolia to estrogen therapy:

1. Side Effects: Some patients may experience adverse effects from Prolia, such as joint pain or skin infections.

2. Post-Menopausal Benefits: Estrogen therapy can be especially beneficial for post-menopausal women, helping to maintain bone density and alleviate other menopausal symptoms.

3. Long-Term Management: Prolia requires continuous use, and discontinuation without a follow-up treatment can lead to rapid bone loss and increased fracture risk. Estrogen therapy can offer a long-term alternative for some patients.
   

Understanding the Risks

Stopping Prolia or missing a dose can lead to significant risks:

• Rapid Bone Loss: Discontinuation of Prolia can cause a rapid increase in bone turnover, potentially leading to a significant loss of bone density.

• Increased Fracture Risk: The risk of fractures, particularly vertebral fractures, can increase after stopping Prolia, sometimes within 7 months after the last injection.

• Rebound Effect: The rate of bone resorption may accelerate beyond baseline levels, heightening the risk of multiple vertebral fractures.
  

Steps for a Smooth Transition

1. Consult Your Healthcare Provider: Discuss your options with your healthcare provider to assess your specific situation and get personalized advice.

2. Bone Density Monitoring: Regular DEXA scans during the transition period will help track changes in bone density and adjust treatment plans accordingly.

3. Gradual Transition Plan:

• Overlap Therapy: Your healthcare provider may recommend a period of overlap between Prolia and estrogen therapy to ensure continuous bone protection.

• Alternative Medications: Temporary use of bisphosphonates may be advised after stopping Prolia and before starting estrogen to maintain bone density and mitigate the rebound effect.

1. Lifestyle Modifications: Enhance bone health with:

• Diet: Ensure a calcium-rich diet and adequate vitamin D intake.

• Exercise: Regular weight-bearing and muscle-strengthening exercises.

• Avoid Smoking and Limit Alcohol: Both smoking and excessive alcohol consumption negatively impact bone health.

1. Regular Follow-Ups: Frequent follow-ups with your healthcare provider are essential to monitor progress and make necessary adjustments.
   

Benefits of Estrogen Therapy

Transitioning to estrogen therapy offers several benefits, especially for post-menopausal women:

• Bone Density Maintenance: Estrogen helps maintain bone density and reduce fracture risk.

• Menopausal Symptom Relief: Alleviates hot flashes, night sweats, and vaginal dryness.

• Cardiovascular Health: Beneficial effects on cardiovascular health in some women.
  

Transitioning from Prolia to estrogen therapy requires careful planning and close collaboration with your healthcare provider. By understanding the risks and following a structured transition plan, you can maintain bone health and enjoy the additional benefits that estrogen therapy offers.

By Dr Purity Carr

GP & Menopause Doctor

Harvey, WA, #drpuritycarr