@hollygs, thank you so much for your thoughtful post. My autoimmune problems have likewise had an enormous impact on my life (loss of a career, etc.), and I have worked hard for the past 40 years to be somewhat "normal." With age has come spinal stenosis, which adds pain to the equation, so I am thankful at least that my heart is stable (pacemakers are pretty miraculous!). But I dread adding another drug to the mix and possibly making life even more of a challenge.

I have had great difficulty finding a physician who is really up to date on the osteoporosis drug research, which is nuts, because the Austin metro area is full of good doctors. But endos and rheumatologists seem to be prescribing by the old accepted formula: Tymlos followed by Prolia followed by Reclast. I am on the verge of paying a ton of money for Doug Lucas' Optimal Bone Health program, but even if I do that, I will have to have a local physician prescribe Evenity, Prolia, or Reclast, because they are given in clinic.

Another issue: Lucas' program for individuals starts off with a complex lab work up, and by the time his folks get results and make recommendations, I will already be done with Tymlos and likely losing bone. (I have been warned that that happens very quickly.) I also have been told that a cardiologist would need to be in the mix when it comes to recommendation because of the warning on Evenity. My cardiologist has pronounced Evenity worth the risk for me, but he felt an endo should make the final decision, so I worry still.

I have educated myself as to osteoclasts, osteoblasts, P1NP, CTX, relative risk reduction vs. absolute risk reduction, and treatment sequences until I'm crosseyed, and I keep coming back to the reality that I won't be able to foretell how I'll react to any drug. I did receive some responses from folks in the MayoConnect autoimmune illnesses group, and their experiences with osteoporosis meds have been mixed. But your idea of doing a deep dive per individual comorbidity makes a lot of sense, and I thank you for that!

Could you please let me know how long you were on Evenity and what your experience with it was like? I realize our experiences are all so individual, but the more info I gather, the calmer I tend to feel about the whole situation! 🙂

Thanks again for your good wishes and your support. I do appreciate!