Need Advice - What drug to Follow Up Evenity

prehorselover,
I don't like Prolia after Evenity. The last 10 month of Evenity are antiresorptive. It makes little sense to me to take another antiresorptive after Evenity. Forteo after Evenity makes the most sense.
I don't like the mechanism of action of Prolia. Reclast is little better.
HRT is going to be really helpful, bones and brain.
We have these highly intelligent physicians who've studied all this. I might be missing some crucial piece of information.

Interesting perspective. Thank you!! I’m trying to find out if it’s possible to follow Evenity with Forteo. Most people either go with Prolia or Reclast. I want to build as much quality bone as possible then get off the drugs. I’ve read that HRT stops bone loss, but it doesn’t rebuild it. I’m not sure if that’s true.

HRT does both. It directly inhibits osteoclasts and prevents apoptosis of osteoblasts. It isn't fast the way Forteo or Tymlos or Evenity. I wonder how much it would hold gains after any one of the three.
I wonder what a transition from Evenity to Forteo would look like.
The chart from gutdad below is a little scary.
This from windyshores:
"In reply to @gently "Windyshores, your thoughts. Reclast after Prolia makes sense to me (though the use of Prolia does..." + (show)
@gently my doctor told me they aren't really sure how Evenity works. But they do know that it's anti-resorptive properties don't "lock in" gains from its anabolic action.

I think the effects of sclerostin inhibition are still not well-investigated and I believe Evenity isn't even a strong anti-resorptive (I have to double check that chart on CTX in last months) so there are mysteries here.

I don't think any research has been done on Forteo or Tymlos after Evenity. I was initially told that I could do Evenity after Tymlos or Forteo but not the other way around. At one point I read that the reason for this is that Evenity is so potent that there is little left for the other drugs to do.

I have only seen videos relating to Evenity after Tymlos or Forteo, never the other way around. We need more research! "
https://www.inspire.com/groups/bone-health-and-osteoporosis/discussion/treatment-after-evenity/

Can you share your current T-scores? It makes a difference on the drugs that you might choose after Evenity.

Thank you for responding. I watched one of your videos last night. I’ve only have one DXA scan.

DXA SCAN T-scores 12/28/22
Lumbar Spine -2.5
Left Hip -3.0
Right Hip -3.1

I’m due for another. This may be a foolish choice, but I want one with TBS. I have an appointment July 3rd. I can get a regular one sooner.

I broke my shoulder 1/19/2022. My Orthopedic surgeon pointed out on my X-rays that my “bones were thin.” Six months later, after I started Evenity and HRT, there was a visual dramatic difference on the X-rays.

I suspect my bone quality is good. Just before I was officially diagnosed, I bought a yearling horse. He has knocked me down 5 times and stepped on my leg twice. I’m fine. Horse is in training now.

Thank you! That’s good to know about Forteo and Tymlos!

I’m a test case on following Evenity w HRT. I’m WAY behind schedule to start a follow up drug. I have terrible insurance. And I recently jumped through a lot of hoops to switch in order to get better care. The timing is bad, because I couldn’t get an appointment with an endocrinologist until October and a DXA scan until July 3.

Meanwhile, the previous rheumatologist had ordered Prolia. Who is supposed to be delivered on Wednesday but it wasn’t. I am an able to get anyone in the rheumatologist office to return my call. It’s frustrating. I’m hoping it turns out to be a blessing in disguise!

Hi @prehorselover - Being around horses can be hazardous for sure. Be careful 🙂

Good to hear your X-rays indicate some positive bone building. If all went well, you are likely out of the osteoporosis range for the hip and for sure the spine. That said, you want to move soon to your next medication to keep the gains you have made.

If you could be a DXA scan done in the next week or so, that would be best to confirm your Evenity results. Without knowing your current T-scores, I would guess Fosamax (alendronate) would be a good choice. Hopefully after two years, you will be able to take a break with no medication for a few years before restarting Fosamax (cycle repeat).

Don't wait too long to start your next medication. You want to lock in those gains and waiting more than a month is not wise. I started the day my treatment ended.

I think HRT is a great idea as well as most every doctor I have heard on the subject of osteoporosis. However, I'm pretty sure you can't just use HRT to lock in the Evenity gains. You still need a drug like Fosamax.

Good luck!!!
Mike

I’ve never taken Fosamax. My orthopedic surgeon advised against it, so I went straight to Evenity.

Then I was referred to a Rheumatologist, who is very nice, but she doesn’t use tests (bone markers) recommended by the experts I follow on Social Media. She recommended Prolia and ordered it. I can start anytime after I get a blood test for Vitamin D and something else. I don’t remember.

You recommended on your video getting a CTX text. I requested that the doctor include that in the order. The assistant had never heard of CTX. I’m hoping it’s an option. Is there another text you recommend?

I’ve been worried about the delayed length of time after ending Evenity and starting Prolia or another drug. My rheumatologist said it wasn’t a problem, but I don’t fully trust her opinion. Starting immediately makes more sense. Good for you!

It may not be true that one has to take the next drug immediately after ending Evenity. Especially since the last months of Evenity are anti-resorptive. Granted one should not wait too long but the urgency may not be as you are stating it to be.

I hope you’re correct!! Thank you!!