Hi @hopeful_cath01 I was diagnosed as Stage 4 Denovo with bone mets in Oct 2018. I started the same regime of drugs you have Ribo's, Letrozole and Denosumab. The protocol is/was to start you on the highest dose of 600mg. The studies showed that a large proportion of people just can't stomach that dose due to side effects, the most common being nausea and low neutrafils. I too suffered immensely on 600mg with nausea even with the maxelon and neutrafils went too low. So after some trial and error, many side effects, down to 400mg then down to 200mg. My body found my happy place was 200mg with minimal side effects, no nausea and I've been on that dose since then. The lower dose is just as effective as a higher one, its just that your body has to find the happy place where it can deal with them. Please discuss this with your Oncologist... When I started the drugs were still fairly new so I went thru several cycles to try and find the sweet spot for me and I had varying and different side effects each cycle til I settled. Please note all your side effects and discuss them with your Onco... your quality of life is important too. :) Best wishes, take care. Hugs Elise