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Prolia vs. Evenity
I am just finishing two years on Tymlos and am faced with the awful choice of Prolia or Evenity. I have controlled heart disease (cardiomyopathy) and am doing well in that regard. Because of the cardiac warning on Evenity, some practitioners will not prescribe it for me, although my endo is willing because my cardiologist says given my recent test results, he doesn't see me as a heart attack or stroke risk. Then, of course, he reminds me that he's "just the plumber," not an expert on osteoporosis, so his opinion that Evenity would be safe for me stops being entirely reassuring. I've seen a study stating that Evenity might NOT actually cause cardiac issues, but I haven't seen anything definitive yet.
Where Prolia is concerned, I am worried about consequences to my immune system, as it is a documented infection risk, all sorts of things from cellulitis to endocarditis. I have lupus and two other autoimmune diseases, as well as unexplained skin problems, and I am already on Entyvio, which is a minor immunosuppressant (gut only) for UC. My allergist calls my immune system hyperactive, as I've become hypersensitive to everything: odors, most every airborne allergen, the sun, detergents, etc., etc., etc. Sometimes just pressure on my skin will start rashes.
Also with Prolia there's the documented nightmare of vertebral fractures if one has a bad side effect and has to go off it. My endo has told me that if I have to stop Prolia, I will have to start Reclast, which is a bisphosphinate that can cause osteonecrosis of the jaw and atypical femur fractures.
Of course, both Evenity and Prolia also can cause osteonecrosis of the jaw, though Prolia more so than Evenity. And both can cause atypical femur breaks, though I haven't been able to find a statistic showing which drug is more culpable in that regard. Both also can cause so-called "hypersensitivity reactions" like hives, rashes, shortness of breath, though I don't know which drug is worse that way either.
As for joint and muscle side effects: I am 73 years old, have lumbar stenosis that causes me pain from the waist down, and it gives me the willies to hear from some MayoConnect folks that both Evenity and Prolia can cause severe bone & muscle pain. But my osteoporosis is severe enough (T score -3.4 in total hip) that I need to be on a drug.
Is there anyone out there who can help me decide which drug to use? I've watched medical videos (Dr. Doug Lucas and Dr. Ben Leder) and tried to educate myself and I still worry that I'm in trouble no matter which way I go. My 2 years of anabolic (Tymlos) helped my spine but got me only minimal gains in my hip/femur. Bottom line is that my endo is leaving this decision up to me.
One other thing: I have read with interest posts re: using low doses of Reclast, but am wondering if anyone knows whether Prolia or Evenity doses can be lowered, and if so, whether that's effective.
Thanks in advance for any help you all can offer!
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I'd take Fosamax for the time being until I could get the appointment. There is no way I'd pay someone $13 grand. That's a crook preying on desperate people.
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2 Reactions@njx58, wish I could take a pill, but I've got esophagitis, so no oral bisphosphinates for me.
When exploring programs and supplements that support osteoporosis and bone health, it's essential to be an informed consumer. Research the qualifications of the practitioner and look for scientific studies on safety and effectiveness of their approaches.
Out-of-pocket programs in particular should be thoroughly researched and vetted. While some therapies may be safely used alongside proven treatments, others may make unsubstantiated claims or exploit fears about conventional medicine. Always approach additional treatments with a balance of optimism and caution.
In particular, be cautious of products or programs that promise quick or miraculous results—if it sounds too good to be true, it probably is.
Finally, remember that experiences shared on Mayo Clinic Connect are not a substitute for professional medical advice, diagnosis, or treatment. Never delay seeking professional medical guidance because of something you've read in the community. https://connect.mayoclinic.org/blog/about-connect/tab/disclaimer/
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1 ReactionHi @bayhorse, choosing the right treatment can feel really complicated when you are managing other health issue at the same time. It can definitely feel overwhelming - I know I would if I were in your shoes. The key is to work with a physician who is well versed in both medications and your underlying medical conditions. I know even finding the right doctor can be a challenge in itself!
Have you watched the YouTube video on osteoporosis drugs and cardiovascular diseases?
at 27:51, the presenter discussed romosozumab's (evenity) effects on cardiovascular risk. The information comes from 2024 Santa Fe bone symposium and may be useful to you.
There have been studies on bmd loss after discontinuation Forteo without any follow-up antiresorptive therapy. On average, the lumbar bmd declines about 4-7% within the first year, with continued loss thereafter. Most studies showed a return to baseline within 24-30 months if no antiresorptive follow-up. However, the monthly rate of decline wasn't calculated or was difficult to track (may not be linear), so it's hard to say exactly how long one could wait before taking any action. There seems to be a lack of direct studies on Tymlos in this area, however, teriparatide (Forteo) offers the closest available comparison.
I truly hope you will soon find a path forward that you feel comfortable with, with the help of your physicians and any other specialists. Wishing you all the best!
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2 ReactionsHi @bayhorse. I don't know if there are any definitive studies regarding the ideal window for starting a new medication after Tymlos. What I have read is is anecdotal - informative for sure but certainly not ideal. I just saw @mayblin's reply and hope you find it helpful. Do you have a pharmacist that might be able to help you obtain more information regarding that? Perhaps the pharmacist at the infusion center would be able to offer you some information - I found that to be the case for me.
I certainly understand how exhausting this can be. As always, wishing you all the best moving forward.
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1 ReactionDoctors are not trained on causation or natural approach. They treat the symptoms. Why not do both, holistic and traditional?
I have a lot of sensitivities similar to yours. Artificial fragrances put me into anaphylaxis. I have cardiovascular issues. My choice was Forteo or Evenity. I have has cancer 3 times and since there had been some concern about a cancer link with Forteo, I took my risk with Evenity to build bone first. I had no problems with it. Then I followed up with Reclast infusion to keep the bone. I haven’t had a dexa scan yet to find out how it is all working. That will be in September. Best wishes!
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1 ReactionIt may be helpful for you to read the manufacture's website for both Evenity and Prolia. Evenity is designed to help build bone and Prolia is designed to strengthen and maintain existing bone.
https://www.evenityhcp.com/why-evenity/choose-anabolics-first
https://www.prolia.com/taking-prolia/postmenopausal-osteoporosis#starting-prolia
@kallettla, thanks so much for responding. Would you mind letting me know what your cardiovascular issues are? The cardio warning is what's stopping one of my docs from giving me a go-ahead on Evenity, which is the drug I would rather take than Prolia. (I have already finished 2 years on Tymlos, which is the daily injectible like Forteo.)
Thanks much for weighing in. I wish you all the best of health!
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2 ReactionsThanks, @dcg. I've read both and spoken at length to patient info people at Amgen, and am still not getting certain questions answered about Evenity. For example, no one is willing to look at the after-market statistics re: cardiovascular events, even though the stats must be there. A supervisor (patient info department) was supposed to call me last week and never did. Worst of all, the Amgen nurse who I was talking to about Evenity gave me some wrong information, which I discovered when I read the study data in the prescribing info. So disappointing and exhausting...
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