Post Evenity DEXA numbers

I did all possible adjustments including GE and Hologic conversion from g/cm2 to mg/cm2 based on the online conversion “app”. Femur ranged from 6.5% - 19.3%, Spine from 10.9% - 35.8%; down from my original comparison using T-Score. I’m thrilled! All the hard work seems to have paid off in some respects.
I met my new endocrinologist today and she recommended Prolia for 3-4 doses and switch back to Evenity to build more bones. Evenity needs at least 1 year sabbatical (😜) before going back to. She said Prolia is a stronger medicine than Reclast; as long as there is follow-up switch to a different med, the rebound fracture issue should not be too serious. I was originally inclined to do Reclast but now am thinking of Prolia as a transitional med before Evenity again.

What’s your thought on this? Thanks!

These are very impressive gains— congratulations!

I've read that a few members on this forum followed a similar path: they used Evenity first, then transitioned to Prolia for 2-3 injections in hopes of achieving further BMD gains. Based on their posts, they're planning to switch to Reclast after completing the Prolia doses.

Your endocrinologist makes a valid point about taking a one-year "sabbatical" from Evenity. I believe it was during last year's Santa Fe Bone Symposium that several specialists mentioned the idea that "bone doesn't want to keep building" indefinitely.

There is a clinical study (small) that looked at a sequence of Evenity → 2 Prolia injections (1 year) → Evenity. BMD outcome is shown in the graph below. The full publication link:
https://pmc.ncbi.nlm.nih.gov/articles/PMC6877701/
Keep in mind, though, that this study used a shorter duration of Prolia than what your endocrinologist is proposing. As many of us now know, the risk of rebound bone loss increases with more doses of Prolia. If you end up having four injections, will Evenity's antiresorptive effect be strong enough to counteract a potential rebound? That's definitely something worth discussing with your endocrinologist.

Are you able to take a bisphosphonate orally?

Thanks for your comments! The curves are encouraging! Wish there was a comparison between Prolia and Reclast as transitional medicine. I may just do the Prolia-Evenity sequence. I have meeting with my Dr at 6 months interval to evaluate Prolia efficacy. I’m sure she won’t object to 2 does if necessary.

I can take bisohosphonate orally I’m sure but my main goal is to build bone as fast as I can and also to avoid fractures. I don’t want to go through that again!

I forgot to post my TBS. Here you go. It seems I’m not that good yet. My Dr said it will improve with bone build.

Hi @laurensb

I agree with your thoughts about Prolia - I am also 69 and my doc wants me to start it this month. Thanks to the members here who alerted me to "once on Prolia, always on Prolia." I'll be trying to go back to Reclast which has worked well for me in the past. However, I may have had too many lifetime infusions already.

I would happily take Fosamax, but because of the side effects I've had from Tymlos, I have GERD and don't think I'll be able to tolerate it.

I wish you well! Cheers!

Thanks for sharing your experience.

The BMD outcome from Evenity -> Prolia (2 shots) - > back to Evenity looked good overall. But I didn't see too much of a hip BMD increase after the first round of Evenity, and there's no FN data available. The spike in CTX during the second round of Evenity is something to keep an eye on. If you go this route, it's a good idea to have a plan B just in case.

There are studies comparing Prolia → Evenity vs Fosamax → Evenity (see graph below). From that, we can kind of infer what might happen with Reclast → Evenity.

The reason I asked about how you tolerate oral bisphosphonates is because risedronate (Actonel) or the delayed-release version (Atelvia) might be good options for bridging between two rounds of anabolic - Evenity in your case. This was actually discussed at last year’s bone symposium. I believe @awfultruth is doing exactly that.

Wishing you the best of luck - please keep us posted!

Thank you for this discussion.
Does anyone have any information about Evista to sequence after Evenity? or in this disuccsion group - between 2 courses of Eventy/
It is known that Bisphospanates and Prolia can reduce the effectiveness of Evenity - so prehaps its possible to avoid this consequence by using a different class of drugs?
Healing prayer for you all.

Great that you brought this up!

I think raloxifene could potentially be a good option. However, its association with an increased risk of venous thromboembolism (VTE) is important to discuss with prescribers - especially for individuals with a history of VTE or other risk factors for blood clots. Another consideration is whether raloxifene is strong enough for patients with high baseline bone turnover, as indicated by elevated CTX levels, since it's a relatively weaker antiresorptive agent. That said, its action is easily reversible which makes it a useful option for bridging between two courses of anabolic therapy.

HRT is another agent with a reversible effect, but it's not considered a first-line treatment for osteoporosis. Additionally, there can be reluctance to prescribe it, particularly for older postmenopausal women.

Neither agent offers a substantial reduction in fracture risk (20-40%), which may limit their use in osteoporosis treatment, especially for individuals with a history of fractures. Using either agent as a bridge between two courses of anabolic therapy is an interesting approach worth discussing with a physician.

Thank you for reply and consideration.
I respond powerfully to medication. 6 weeks on actonel was enough to get me protection / plummeting my bone markers; but with increased inflammation and acute phase reaction. So I need another class of drugs if possible .