Evenity, Prolia and Reclast work in very different ways. Evenity inhibits sclerostin. People with naturally low sclerostin have very thick bones and that gave researchers the idea to use it for osteoporosis.

I have read that initially they thought Evenity would only build new bone, the whole year (anabolic). But the P1NP bone marker for anabolic action goes up abruptly and then comes down. At least for the last 6 months, Evenity is anti-resorptive (like Prolia and Reclast but with a different mechanism) but less strong. So yes there is some risk of osteonecrosis but various sources of info (see below) say that it is not as much of a risk as with the other two.

If first 4-6 months are more anabolic, there is always the option to do those months. As another patient with high fracture risk, I did Tymlos and then just 4 months of Evenity. Because I only wanted the anabolic months.

For reference, "Great Bones" by Keith McCormick and Dr. Ben Leder's two videos on You Tube (he is an endo at MGH) are the sources of my information. Dr. Leder, in "Combination and Sequencing Approaches to Osteoporosis" has an excellent graph that shows both the anabolic and anti-resorptive action and timing of those phases on Evenity. That said, my doctor says they don't really understand how Evenity works.

There may be someone who has posted or will post here about having jaw issues on Evenity. I am just responding to the statement that Prolia, Reclast and Evenity are in the same class. Yes they all are anti-resorptives but Evenity is not the whole time and is not as strong an anti-resorptive as the other two. All three have very different mechanisms for bone density growth.

Your endo can explain this and I hope a solution is found for you in this hard position.