Need Advice - What drug to Follow Up Evenity

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!

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!

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.

Hello, I have read through your chat on Evenity and HRT and am curious about HRT being started in our 60's. I am 63 and was recently diagnosed with Osteoporosis of the spine (-2.6) and Osteopenia in the hips. The reason for my diagnosis was a number of fractures in my thoracic spine which I am now at the 6 month mark for healing. The fractures came out of no where as I was always active and worked out. No underlying conditions were found. Of course, I was never offered HRT through menopause..

I have had my 4th injection with Evenity and have a call with my Endo this month. I want to understand what happens next (planning ahead) because there is so much controversy about what is required after Evenity.

I am also curious as to when it is safe for me to start working out with weights and heel drops. I have been working out with bands to get my back stronger. I do a lot of balance and training on one leg to build glute strength etc. as every bit helps.

It would be great to hear from others who have had fractures in their Thoracic spine and to know where you are in your healing and work out journey. It is a very isolating experience. I have always been very active and really hope to get back to where if I was (with taking care of course).

I have 4 compression fractures in my thoracic spine, the newest being 2 years ago. I had another MRI last November and they are all stable and no nerve compression. I was pretty much pain free until last year when I started Evenity. After the first injection I have had almost constant and increasing pain mid-back, tingling and burning. I've been told it's probably nerve related, either compressed in a muscle or from inflammation due to osteoarthritis. I get massages twice a week, use resistance bands to exercise my back, stretch and take Meloxicam daily which give me some relief. Unfortunately the increased pain has affected my activity level. Last Fall I was able to walk/run, play with my grandkids, do some gardening, etc. Now I walk some and do my exercises. Depressing. I only have two more Evenity injections (hoping the back pain decreases?) and then a DEXA to see if there's been improvement. I'm going back and forth between Fosamax or Reclast when I'm done.

@prehorselover Ideally we should have DXA scans before and after each year of treatment with a osteoporosis med. I realize there are insurance and money and availability issues but if possible that's what we should all do, imo. If you go from one drug to the next without knowing what the first drug did for you it will be virtually impossible to know what effect you got from each drug. If you do not know that you will not be able to know for sure what to do in the future. For example if you take Evenity for a year you need to know whether it benefited you or not because you may want to take it again in the future. If you got no help from it the first time you would probably choose a different anabolic med in the future. Conversely if you got great benefit from it the first time you might want to take it again in the future. The same goes for all the drugs. It's crazy to take these things year after year just assuming it's working for you the same as it does "on average".

Hello, I have read through your chat on Evenity and HRT and am curious about HRT being started in our 60's. I am 63 and was recently diagnosed with Osteoporosis of the spine (-2.6) and Osteopenia in the hips. The reason for my diagnosis was a number of fractures in my thoracic spine which I am now at the 6 month mark for healing. The fractures came out of no where as I was always active and worked out. No underlying conditions were found. Of course, I was never offered HRT through menopause..

I have had my 4th injection with Evenity and have a call with my Endo this month. I want to understand what happens next (planning ahead) because there is so much controversy about what is required after Evenity.

I am also curious as to when it is safe for me to start working out with weights and heel drops. I have been working out with bands to get my back stronger. I do a lot of balance and training on one leg to build glute strength etc. as every bit helps.

It would be great to hear from others who have had fractures in their Thoracic spine and to know where you are in your healing and work out journey. It is a very isolating experience. I have always been very active and really hope to get back to where if I was (with taking care of course).

Fosamax would not have been the right choice at the start and going on Evenity was a much better solution. Score one for your orthopedic surgeon! But now that you have completed Evenity, Fosamax could be the best choice, but it depends on the results you have so far. In my opinion, you have two paths to follow.

1. Transition to Fosamax for two years and get a DXA scan to see how you are doing. Combined with HRT, you could be in really good shape. If you are not in good shape, you could use Evenity again or you could transition to Prolia for a few years.

or

2. Transition to Prolia for a few years to get your hip T-scores in really good shape. Then you could transition to Fosamax or Reclast.

CTX is the shorthand name. Here is a link to the Mayo Clinic information https://www.mayocliniclabs.com/test-catalog/overview/83175#Overview

Not all doctors use bone markers, but all of the doctors I follow use at least one set of bone markers. There are blood and urine markers available. Since you're in a transition period between medications, measuring CTX (or other markers) is not ideal since it will swing from low to high. Your CTX is likely still being suppressed by Evenity but will swing above your natural untreated level in the next few weeks.

It's nice to have an untreated CTX value, especially if you are considering Prolia. If you can get it now, great, but at this point, I wouldn't worry about it.

As a side note, I bet your spine scores are better than your hip scores because you ride horses. The spine is being stressed more than you hips and femur.

Thank you for sharing that. I wonder why EVENITY would make the pain worse?
My fractures were incredibly painful but I am feeling better although definitely not back to what I was.
I believe EVENITY does have a surge effect which I have read others have had as well (around the 14 day period).
Is there another option for you since EVENITY is causing so much discomfort?