Update Evenity followed by 2 years of alendronate

Posted by hikernurse @hikernurse, Oct 25 7:52am

So DEXA just showed that my 22.9% spine gain is now only 11% meaning I lost that much in a year. And femoral neck about the same loss. So I went backwards considerably but haven’t fractured. Have not seen doc yet (Nov 6)
Frustrated and sad. I had great results from Evenity after a year that continued after 1 year of alendronate and expected continued improvement. Nothing else has changed. I exercise regularly, resistance work, swimming and walking 4-5 miles daily. (very active) Vitamin D is 51. All labs good. Waiting on CTX. Last from May 2025 was 361.
I was hoping for a drug holiday after 2 full years of alendronate. I surprised myself as I tolerated it very well, never missed a dose! I just turned 69 and so far no one will give me HRT. I had a coronary calcium score that was zero. I was worried as my cholesterol was creeping up to 259 with an LDL of 151 but an HDL 66 so I started rosuvastatin 20 mg daily but after the coronary calcium dropped it to three times a week . Now cholesterol is 152 and LDL down to 69 maintaining HDL at 70. This is essentially the only change I made.
No fractures and vertebral fracture assessment was negative.
What do I do next? I need a long term plan. Can I do a short course of Evenity or will the alendronate blunt it. Was the alendronate not strong enough. Should I have gone right to reclast? Is it too late since I’ve already lost so much? I’m scared of Prolia. T-scores spine is now 2.3 and femoral neck is 3.0. I essentially lost BMD everywhere taking alendronate this last year! I just don’t understand. Any input most welcome 🙏

Interested in more discussions like this? Go to the Osteoporosis & Bone Health Support Group.

nycmusic | @nycmusic | Oct 30 10:27am

In reply to @nycmusic "@mayblin translate this.." + (show)

@nycmusic thanks for the info.clarifies one of my questions.

gretch19 | @gretch19 | Oct 30 11:31am

I am in a very similar situation with the exception that I had 2 Prolia shots folling 12 months of Evenity. My Dr now wants to follow that with Reclast in January, however, I really want to avoid bisphosphonates at all cost due to the rebound effects. I have been experiencing jaw pain and the idea of an infusion really scares me. The alternative is an oral bisphosphonate like Alendronate however they do not seem to work, as you have described. I'd welcome any alternatives/suggestions.

gravity3 | @gravity3 | Oct 30 1:33pm

In reply to @gretch19 "I am in a very similar situation with the exception that I had 2 Prolia shots..." + (show)

@gretch19

I am in the same situation but have been on bioidentical hormone replacement therapy for a bit over a year. I believe that because I have had only two shots of Prolia that the risk of very active rebound would be lessened but other here have more knowledge and experience of that than I. I will be discussing this with my endocrinologist next month as well as my questions about whether a smaller dose of reclast combined with my bhrt would be effective enough to handle prolia rebound. I would like to see if a second year of evenity would be useful after the reclast runs its course. I am 77 but just dont feel like I want to be on Prolia until I die. The actuarial tables give an average of 84 for a gal of my description. We'll see what the doc has to say. Please let us know what path you choose if you don't mind. There is so much to learn from our individual choices and experiences.

grammy9 | @grammy9 | Oct 31 10:41am

In reply to @hikernurse "@gravity3 I don’t know that right now but I would think if the doc does all..." + (show)

@hikernurse
I feel like I am in the same situation. I have 5 more Evenity injections and my doctor is set on Prolia. I don't want to do this drug. Then...I am scared of Reclast too. But..aldronate is only thing I know of that's left. I hate to lose any gains I have received. I am 63.

hikernurse | @hikernurse | Nov 7 8:17am

Updating….I saw my regular endocrinologist and another integrative endocrinologist that is pay out of pocket for a second opinion. Neither can understand why alendronate didn’t hold my gains. Essentially ruled out new secondary causes. Both recommended Evenity again (12) since it worked so well the first time. Neither thought I needed to postpone bunion surgery which is one week from today. I have original medicare and so it looks like it will be covered since i receive at the hospital infusion center and have a -3.0 hip and failed alendronate. I’ve had 4 fractures 2 wrist and 2 rib on separate occasions so I’m considered high risk. The biggest question is what can I do after Evenity. My regular endocrinologist doesn’t think reclast is an option since I failed a bisphosphonate (alendronate) so that leaves the dreaded prolia…. I have time so I think during my bunion recovery I will put everything together to discuss with Dr McCormick. And continue with all the other lifestyle modalities ( weights, collagen, calcium, vitamin D, magnesium, vitamin K, walking, prunes, protein etc…..
I was able to get orders for CTX which I will do quarterly even though the doc said ‘why since you know they were decreased before when you were on Evenity’……….I don’t know what I’d do without all of you!!!!

missey | @missey | Nov 8 8:19am

In reply to @gretch19 "I am in a very similar situation with the exception that I had 2 Prolia shots..." + (show)

@gretch19 I had my first infusion with re-classed, and it was very easy to do. My side effects were feeling very tired for 2 to 3 days resolved by taking naps. I felt fluish also, but easily managed.

rjd | @rjd | Nov 8 10:17am

In reply to @hikernurse "Updating….I saw my regular endocrinologist and another integrative endocrinologist that is pay out of pocket for..." + (show)

@hikernurse
I am in a similar situation. Alendronate did not preserve the gains I made on Prolia.

If you or anyone knows or learns of any studies/authority for using Alendronate to preserve gains while on other meds, could you please share that info?

Clearly, my main motivation was to prevent Prolia rebound but I am disappointed at losing almost all the gains.

gravity3 | @gravity3 | Nov 8 10:53am

In reply to @rjd "@hikernurse I am in a similar situation. Alendronate did not preserve the gains I made on..." + (show)

@rjd

I am sorry the gains you achieved. I am curious. What was the rationale for using alendronate to stop prolia rebound? What is next for you?

gravity3 | @gravity3 | Nov 8 11:09am

Forteo seems to work very well for the spine. Is that an option for you?

rjd | @rjd | Nov 8 12:33pm

No problem with spine. Osteo problem in hips.

I just posted most recent and historical data on the Help With Discontinuing Prolia thread.

My PCP wanted me to stop Prolia cold turkey after 2 injections because it was so successful. Had to convince him with a study that something was needed to counter rebound. At least he read the study/report and then recommended alendronate, which I had been on previously for years without complications.

I have a new PCP and too many other medical matters at present, at least one rather critical, to get a better fix on this doctor's philosophy. I want a drug holiday and think my bio markers support that position.

Thanx for any comments or ideas.