Tracking Results with Evenity

@cat1203 I would be interested to know whether the doctor recommends a drug holiday without alendronate, and for how long, before starting Evenity. Evenity is so new, that little seems to be known. I might also research Forteo and Tymlos after alendronate, since Evenity is anti-resorptive (like alendronate) for the last 6 months. I have seen a chart on all this somewhere and will try to find it!

@windyshores he has not recommended a drug holiday before starting any new anabolic--Forteo and Tymlos also are on the table at this point. It will partly/largely depends on what/which my insurance will cover and what co-pays will be, which is still under investigation. Since alendronate stays in the body so long I'm not sure a drug holiday would help mitigate the "blunt" effect.

Hi @cat1203 your case will be interesting, to start evenity with a past treatment history of fosamax for 4 years.

There was a clinical trial STRUCTURE, showing the results of such sequencing.

In STRUCTURE, after patients had switched from alendronate/fosamax (4+ years) to romosozumab/evenity, serum PINP increased by 34 µg/L above baseline at month 1 and remained above baseline throughout the 1 year of treatment. Serum β-CTX was largely unchanged, decreasing slightly at month 1 and then returning to baseline for the remainder of the 1 year of treatment.

You could use p1np to monitor the bone building effects of evenity. Do a baseline before the start, and do another testing at 1 month. If your doc doesn't like to do bone markers, then you'd just finish the whole year and use dexa to know the results.

In STRUCTURE, after patients stopped alendronate, mean BMD increased 9.8% with 1 year of romosozumab at Lspine, while mean BMD increased 2.9% at total hip; compared with the romosozamab first sequence 13.7% and 6.2% respectively.

Note that not everyone would have equal response. For example, in STRUCTURE, for hip bmds 47% of patients had a greater than 3% increase while 14% of patients had a greater than 6% increase. For lumbar bmds, 91% of patients had a greater than 3% increase while 75% of patients had a greater than 6% increase.

Best of luck!

Thank you @mayblin

Do you have a link to the STRUCTURE clinical trial?

Although my doctor does not use bone turnover markers he will order them upon my request, but I can actually order them myself. It's my understanding it's the relationship between CTX and P1NP, not the actual numbers themselves, that is important to track but I'm no expert and am still learning about this. I likely will order them before I start any new treatment and then once I am into it 2 or 3 months and try to figure it out as I go along.

Here you go, then download the pdf from there:
https://scholar.google.com/scholar_lookup?&title=Romosozumab%20%28sclerostin%20monoclonal%20antibody%29%20versus%20teriparatide%20in%20postmenopausal%20women%20with%20osteoporosis%20transitioning%20from%20oral%20bisphosphonate%20therapy%3A%20a%20randomised%2C%20open-label%2C%20phase%203%20trial&journal=Lancet&doi=10.1016%2FS0140-6736%2817%2931613-6&volume=390&pages=1585-1594&publication_year=2017&author=Langdahl%2CBL&author=Libanati%2CC&author=Crittenden%2CDB&author=Bolognese%2CMA&author=Brown%2CJP&author=Daizadeh%2CNS&author=Dokoupilova%2CE&author=Engelke%2CK&author=Finkelstein%2CJS&author=Genant%2CHK&author=Goemaere%2CS&author=Hyldstrup%2CL&author=Jodar-Gimeno%2CE&author=Keaveny%2CTM&author=Kendler%2CD&author=Lakatos%2CP&author=Maddox%2CJ&author=Malouf%2CJ&author=Massari%2CFE&author=Molina%2CJF&author=Ulla%2CMR&author=Grauer%2CA
Ideally, for a treatment naive patient to start an anabolic, it's best to get a baseline of both p1np and ctx then monitor their changes periodically after the start of treatment. The dynamic changes between the two will indicate anabolic effects (or not). In this particular alendronate to evenity sequencing, the ctx is suppressed to start with and remained almost flatlined during therapy, it will be more important to monitor p1np, especially during the initial phase of evenity, i.e., at 2weeks or 1 month. I think waiting till 2-3mo into the start of evenity to test bone markers will be too late, this is evident as shown in fig5. Getting both bone markers tested wont hurt, might be better, but p1np for sure for this sequencing. It is intersting to note that this trial compared evenity vs forteo following fosamax. The forteo arm showed a much attenuated effect when compared to evenity. Since treatment length being 1 year, we don't know if 2 year treatment of forteo would have a different outcome.

Definitely ask your doc to order bone markers, this will allow the lab to bill insurance, whereas you'd pay out of pocket if you were to order the lab online on your own.

Thanks so much, @mayblin I've downloaded it and will read it. Don't know if my insurance will cover the BTMs but worth a try.

My doctor doesn't use bone markers at all. He says an entire conference could be focused on this issue. He says that they don't tell the whole story about what is going on in bones. I do know that kidney issues can affect CTX, along with food and time of day.

I went to another doctor who does do bone markers, as a second opinion, as well as Keith McCormick, but so far my bone marker testing has not been particularly helpful and the results don't seem to match expectations, probably because they were not done at the proper times, but who knows. I am not really worrying about bone markers being done at this point, but hope they help others guide treatment.