Would you transition from denosumab to anabolic agents in patients who are in urgent need for extensive dental work?

From my experience, this is a catch-22. If you stop the Denosumab you will markedly increase osteoclastic activity throughout the entire skeleton which is why it is recommended that you not stop the medication without some other intervention. I have had several patients with either osteonecrosis of the jaw or not being able to take a tooth implant because they had been on Fosamax. I found that Forteo was very effective in stimulating osteoblast activity thereby helping to reverse osteonecrosis of the jaw as well as help my patients have a good success with tooth implantation. Under your circumstances, I think it is reasonable to remain on Denosumab and add Forteo either 20 or 40 mcg daily. The study (Tsai et al., PMID 31447409) demonstrated...

I agree with Dr. @Dr. First Last. Teriparatide and abaloparatide are remodeling-based anabolic drugs. When you stop denosumab there is increased osteoclastic activity and loss of BMD. If you start a PTH anabolic the anabolic response is often quite robust Ignore BMD for a second and think about the biology of the drugs which requires vigorous osteoclastic activity as part of the remodeling biology. My group (ortho) takes on a fair amount of non-unions or delayed unions (including atypical femur fractures). Some of the most vigorous callus formation I have seen is in people who for one reason or another stop denosumab. By the way, even the BMD catches up in the patients in the 4th year after stopping denosumab!