Which option to pick???

clowny, I am sorry you are not feeling well on Evenity. I will have to switch off my bisphophate soon and am looking at options. I think my Medicare Part B insurance only pays to have a Dexa every two years. If yours is like mine, maybe you are within that two-year time frame. If it has been more than two years, I have no idea why insurance won't pay. Also, it may not be reasonable for your MD to spend time appealing much of anything right now. They are a very financially stressed industry, and have been under stress for awhile. My practice is owned by the local hospital that is owned by a venture capitalist firm. That may mean that some MDs, including my internist, are employees who can't practice medicine as they would like.

@seniorhope66 I'm going to share my experience which led me to take Evenity injections for 12 months followed by a Reclast infusion as recommended by my endocrinologist.

I am 73-years-old. My mother had osteoporosis that resulted in a shoulder fracture and hip fracture when she was in her late 60's and she was very frail toward the end of her life. So, a history of osteoporosis in my family is present.

I was diagnosed with osteoporosis about 10 years ago. After doing everything I could to maintain and build bone density including weightlifting, weight bearing exercise and nutrition, my bone density, as evidenced by bone density scans, bone density did not improve. Per my primary care physician's recommendations, I took Fosamax for 5 years. After 5 years I had a bone density scan that showed improvement and I was in the osteopenia range. In 2021 at Mayo clinic, a recurrence of endometrial cancer was found and I had external beam radiation therapy. My radiation oncologist at the time told me that this radiation could result in bone density changes and sure enough, it did. I had a sacral fracture about one year after radiation therapy. I've no idea why I had the sacral fracture at that time since there no falls I can recall. At Mayo Clinic I asked for a referral to endocrinology. The endocrinologist who specialized in osteoporosis and oncology reviewed my records and my initial evaluation was an hour duration in length. He told me that I had done everything possible to maintain my bone density and had I not had the sacral fracture he would recommend that I continue doing what I was doing without medication. He said that the sacral fracture changed all that. Medication was now indicated and did I want to do that? So, I watched my calcium intake more carefully (I use an app called Fitness Pal, the paid version, that records my nutrients) and made certain to follow all of my endocrinologist's recommendations.

I had 12 months of Evenity injections. No side effects with the exception of occasional soreness for about 24 hours at the injection sites. After 12 months I had another bone density scan which showed significant improvement in both hip and lower back in bone density. To "lock in the gains" I had a Reclast infusion. No side effects from the Reclast infusion. One year after the Evenity injections and Reclast infusion will be this December, 2025. I am scheduled for blood tests, bone density scan and a visit with my endocrinologist.

By the way, I had two falls while cross country skiing last winter (early 2025). One fall caused serious trauma to my shoulder. X-rays and MRI showed no fractures. The damage was a partial tear in one of the rotator cuff tendons and inflammation in my shoulder. I am still working on rehab of that shoulder and doing well with that. I consider that a win since there were no fractures.

Does this information help you to decide how you'd like to proceed?

clowny: I have had 3 DEXA scans since going on Medicare and they have all been covered. The caveat is that you can only have it done once every two years. So if you have a repeat scan before the two year point then, yes, it won't be covered.

bswpb: I went on Prolia 5 years ago as a last resort. No problems. Then my doctor said she was mandated by the health organization she works for (Sutter Health in Calif.-it's not an HMO but is starting to act like one) anyway, she was mandated to switch to a new biosimilar drug with the same active ingredient called Jubbonti. (It has only been on the market for 3 months. On their website Jubbonti brags about how we can expect the same good results as we get from Prolia but their drug is cheaper) Anyway, had a Jubbonti shot 5 weeks ago and it was a nightmare for me. Bladder inflammation, which I was put on antibiotics for, my intestines still aren't normal, and just a feeling of being unwell. Just wanted to give y'all a heads up. Biosimiliar drugs aren't identical, just the same active ingredient, but your body might react differently to a new formulation.

Yes, true.
I am going to get a scan before the 2 years so we can see how effective Evenity has been.
I will have to pay for it

Maryann,
I am not thrilled about Prolia because of the way it works but I am even less thrilled about new drugs. For whatever reason they are a nightmare for me! So Prolia is it for me unless I have to change!

Gently, thank you for this information. I will definitely ask for slower infusions.

What is the plan after Prolia? It has to be followed by a biphosphonate.

At Medicare email about 3 months ago said that if the DEXA scan is to compare results against a previous one, it can be less than 2 yr interval. The 2026 Medicare booklet says bone mass measurements: once every 24 months (More often if medically necessary) for people who have certain medical conditions (like osteroporosis) or meet certain conditions. Call medicare and ask them re your reason.

If you are on medication for osteoporosis, Medicare will pay for more than one DEXA in a year. I've done it.