Need Advice - What drug to Follow Up Evenity

If a horse falls on you, I think you have more to worry about than broken bones. She said if she falls off the horse.

Sorry, I was being facetious. A fall from a horse can be really bad since you are so high up . Depending on how you fall and land, it would be easy to break a hip even without osteoporosis or osteopenia. All we are doing with meds is trying to lower our risk. I really don't know what the target should be here. Your doctor will likely have better guidance since they have clinical experience.

I received my last Evenity injection mid February 2024. Needed a tooth extraction and an implant placed. Unfortunately the end of May 2024 I was in the hospital with colitis. During my stay I started having severe back pain. 3 weeks later I was diagnosed with another compression fracture and a sacral fracture. I had 6 compression fractions over a 5 month period the later have of 2022 which is why I started Evenity. I’m supposed to start Prolia as soon as my implant is set which is the end of this month. I’m really concerned as to how to proceed. I certainly hope you have better results than I.

My t-score is -4.8, so the endocrinologist wants me to start Evenity ASAP. I am concerned about stroke risk, since I also have AFIB. And what do I transition to when the year of Evenity is up? My mother and aunt both had trouble with Fosamax, so I want to steer clear of that. I envy the person who said they were back on their HRT. I cannot find a doctor to prescribe it for me (I'm 65). I've asked three so far and all have refused, for various reasons, ranging from the fact that I am over 60 to the belief that it will not help my osteoporosis. Should I try to see a rheumatologist before I commit to anything? Would they be more willing to at least think about HRT? I am feeling undone by all this, since these decisions will have definite consequences, either good or bad. Sigh.

@callmekate
I also woud avoid Evenity because of the afib.
I suspect HRT will not be sufficient fracture protection for your bone density .
Have you considered the bone building medications Tymlos or Forteo.
I agree with your endocrinologist's encouragement to begin treatment right away.
I would ask the endocrinologist for Tymlos and ask for an introductory pen so there'd be no waiting.
A gynecologist might be more likely to prescribe HRT.
You could see a rheumatologist or another endocrinologist, except I wouldn't encourage the wait.
Reclast is another option. I consider Tymlos and Forteo better medications, but Reclast would offer you fracture protection.
Bless your struggle with luck

I was just thinking about Forteo last night, since that was another medication offered to me. I have read that it caused bone cancer in rats, but not in humans, and that makes me nervous because I have already had a weird non-bone cancer (thymus), so wonder if I am more likely to develop another. It feels as if I have no good options, drug-wise, and yet I don't want to break a hip or a shoulder or anything else. My gyno is one of the ones who said no to HRT. I know it won't fix my bones, but it sure wouldn't hurt any, and I felt better when I was on it. Oddly enough, my cardiologist is okay with me trying the Evenity. I see her in a few weeks, so can clarify that with her. No matter what I do, I'll need to see my dentist before I can start, to have my unopposed wisdom tooth out. I'll be calling him today. Thank you so much for your reply. I'm so glad I've found this community. Kate

Hi Kate, the thyoma is an interesting complication. Your physicians probably have more information about how, or if, it affects a decision for hormone replacement as well as the use of teriparatide. Do they think that it is a secondary cause of the osteoporosis. If you had it surgically removed, you could have somatic testing (genetic testing of the tumor itself). This would give you information about risk of metastasis and risk of recurrence. wh
Your biopsy material would remain available, but maybe not of sufficient size.
We're equally glad you found us.

Johns Hopkins had this to say:

"Persons with elevated calcium levels, women who are pregnant or nursing, or persons who have ever been diagnosed with bone cancer or other cancers that have spread to the bones, should not use Forteo®. Because long-term treatment effects are not known at this time, therapy for more than two years is not recommended. In animal studies, there was an increase in bone cancer. Although this was not found in humans treated with Forteo, increased risk of developing this cancer cannot be ruled out."

@callmekate A t-score of -4.8 is serious business. I would not rule out Evenity (the most powerful and fastest bone builder) because of AFIB. As to stroke risk and cardiovascular events if you look at the research you see a slight elevation in events in one study and none in the other major study. Certainly if there is an elevated risk it is not great as too many people are taking Evenity now and those CV events do not appear to be happening.
Try to balance the risk of fractures with a -4.8 vs the very slight maybe potential increase in risk (and maybe no increase of risk) with Evenity.
I am biased - I chose Evenity and had great results and no side effects worth even mentioning.

I would investigate the CV and AFIB issues and discuss with doctors but I wouldn't reject it out of hand. With quick searches I don't see any mentions of AFIB with Evenity. There is some concern about AFIB with bisphosphonates which you would likely need after Evenity. Not sure about Prolia. You definitely need a good doctors guidance with these issues.

I would suggest you see a Functional Medicine type doctor for BHRT. My wife starting BHRT in her seventies working with our integrative cardiologist. It is definitely doable and it would probably still help your bones but not work as a powerful bone builder like Evenity.
Good luck to you

Thank you so much for this. My thoughts are beginning to clarify and I am realizing I have limited options and they all come with risks. I wish my cardiologist was open to BHRT. I see her in 2 weeks and will ask again. Thanks again for taking the time to send your thoughtful response. I am so glad I found this group.