@dmshope

You raised an interesting question! The paper you linked looked at a similar sequence, with one small difference - participants received two years of Evenity (not one) at the start.

In Figure 3 of this study, after a year off Evenity (a “pause” without any follow-up medication), bone density dropped quite a bit. This loss may be explained by the sharp rebound of CTX shown in the figure. The second round of Evenity brought those gains back, but only to about the same level as after the first treatment - not much higher. So overall, from start to finish (0–48 months), the net BMD improvement was essentially similar compared with the initial two years, with the lumbar spine showing a slight additional gain.

Would you consider using a milder antiresorptive such as risedronate, raloxifene, or estrogen after the first course of Evenity to help maintain bone density before thinking about retreatment?