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@gravity3 I have been curious about this as well, so I took a look at the ARCH study, The attached graphic is from the study protocol. Based on my interpretation of the protocol, romosozumab injections were administered at visits on day 1 then at monthly visits 1 - 11. A supply of alendronate was provided at the month 12 visit. So it looks like alendronate was started one month following the last romosozumab injection, though the protocol doesn’t explicitly state that.
From a Quick Look at the FRAME study, it appears denosumab was started at the month 12 visit, so also one month after the last romosozumab injection.
I would be really wary of waiting 6 months to start an antiresorptive if the doctor isn’t able to provide a solid rationale.
I used the following link to get to the ARCH study results: https://www.nejm.org/doi/full/10.1056/NEJMoa1708322
Study protocol:
https://www.nejm.org/doi/suppl/10.1056/NEJMoa1708322/suppl_file/nejmoa1708322_protocol.pdf
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@newengland transplant I read the part of the ARCH study you linked and it says Evenity "followed by alendronate" but does not specify timing. Does the FRAME study specify when alendronate should be started? I imagine there is leeway depending on CTX and other markers a month after Evenity is stopped.
ps That link discusses studies on cardiovascular risk which would help people who are scared of the black box warning. No calcification of blood vessels has been seen in studies so far and the link mentions that the difference between Evenity and alendronate results may have been because alendronate is slightly protective. It also mentions the FRAME study where there was no difference is CV risk between Evenity and placebo. The CV risk remains theoretical in other words.
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Thank you for this great information. I will have a shot of prolia next week and I may have a second one and thinking another round of Evenity and then a bisphosphonate.