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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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Hi, @dvargo. The one drug that seems to be suspect where cardiovascular issues are concerned is Evenity. I don't know that any of the other osteoporosis drugs pose any such risk.
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1 ReactionRetrospective studies can be hard to interpret, as they lack the ability of randomized controlled trials to eliminate bias. The high incidence of MACE is likely due to the prevalent underlying cvd among patients. Without a corresponding control group, it's difficult to draw a clear conclusion.
I had Forteo treatment, followed by HRT. I've asked an endo who uses HRT with his patients, and he felt it would be appropriate for me as long as I'm not at increased risk for cvd or breast cancer. Before I saw my cardiologist, I thought HRT wasn't an option for me - but neither he nor the other heart specialist had any hesitation in my case.
@mayblin, it does seem as if definitive conclusions are impossible to draw and more studies are needed. Or as you put it in an earlier post, there are no answers -- at least not yet -- as to the risk/safety of Evenity where cardiac events are concerned.
Re: hrt. My endo refused for me because I am slightly more than 10 years out from menopause and have a heart condition. Likewise my gyn would not prescribe. Are you within the 10-year bounds?
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1 ReactionExactly, you summed it up well! Ideally, your case is best managed via interdisciplinary collaboration, where specialists work together to evaluate the risks of each drug in the context of your specific medical conditions.
I started HRT at 61, 11 years post menopause. The decision is now described as "individualized assessment and shared decision-making process". I wonder if your endo's take on HRT was based on your Tscore and/or FRAX score. In my view, your endo is the one to determine whether HRT is the appropriate agent in managing your osteoporosis, while your cardiologist and obgyn are best suited to assess the potential risks for you.
HRT is generally used as an antiresorptive but is not officially indicated for treatment for severe osteoporosis. It can improve bmd to a certain extent, particularly during the first two years of therapy. So, if you are aiming for significant bmd gains in the near future, your original question still stands, a challenging one, indeed.
Hi, @mayblin. My endo's refusal re: HRT had to do with the fact that I am past the prescribed 10 years past menopause and also am a supposed cardiac/clotting risk. She goes by the book, end of story. I was asking her about HRT only as an adjunct to my next osteoporosis drug because hip-wise, I did so poorly on Tymlos and figured I could use all the ammunition I could get!
Yesterday, I received a note from my cardio's PA saying my cardiologist would look further into the Evenity issue for me and "possibly" be willing to get in touch with my contact at Amgen. I actually spent a few hours crafting a couple of very concise portal replies with a summary of my concerns and questions. Here's hoping I get somewhere. I am technically running out of time: My rheumy has messaged me that one can lost bone density within weeks of going off Tymlos! So there's an answer to that question... though it's not the answer I wanted to hear!
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1 ReactionHi, I am getting my 9th injections of Evenity tomorrow. I am considering stopping the injections after the ninth because of bone pain. (I have sever osteoporosis) I hope I can continue to tolerate the Evenity, but my quality of life has decreased so much I'm not sure I can hold out. I have a serious case of GERD so can only take Tylenol for pain. It helps a little. I spoke to my doctor about stopping and was encouraged to continue but if I am unable to do so he wants me to follow up with Prolia. I'm anxious about the rebound effect of Prolia. Cascade fractures sounds horrific. I am considering Reclast. I've done some research as well as reading Mayo discussion boards but I'm walking away from my computer today as confused as when I started. Any thoughts? Studies that are not solely written for scientists that might clarify the pros and cons of each drug after taking Evenity? I'm almost 76-years-old. Thank you.