What comes after Evenity?

I'll be getting my fourth injections this month. My endocrinologist wants me to begin prolia after I am done but prolia scares me.

I just had my 9th shots of Evenity and am desperately trying to figure out what should come next to lock in any gains. I was already on Alendronate from 2017 after my first compression fracture until fall of 2021. My second fracture occurred in Jan. of 2023 and started Evenity in March. My PCP strongly suggested Prolia and my Oncologist (breast cancer in 2014 followed by radiation -- which probably did my bones no favors) has recommended Reclast, as a follow-up. Neither option sounds appealing, but I will have to do something.

I am doing a 20% test dose of Reclast when I finish Evenity (after Tymlos). McCormick said I could continue with that dose, done more frequently than the full dose. We'll see! I have GERD so can't do Fosamax and my docs don't like to use Prolia, period.

I completed Evinity in October 2024 with no side effects. DEXA results showed 12% increase in spine and less in hips, but moved me to osteopenia. I will begin once weekly Atelvia, delayed-release risendronate, next week. It is taken immediately after breakfast.

There is no question Forteo saved my life. I had signed up for MAID as nothing was working and I was fracturing laying in bed! Forteo finally kicked in, and my spine started to recover. Very greatful. However, I did contact Forteo myself regarding redoing a course of this. I had done the full 24 months 5 years ago. They told me very clearly: "You need to look at other options". This was through the nursing line the I still had a care card for. She also told me they were shutting down as of Dec 2024. So that is why I will be starting Evenity. IF I can get paperwork sorted, as I cannot afford $800.00 a month.

I was on Forteo for 24 months and then Raloxifene for the past 5 years. Just about to start Evenity and also wondering about what's next. I am 66 and Prolia has been recommended, but would have to be "forever". I have not heard much discussion about Raloxifene on this site, but have considered just going back on that, as had no side effects at all. There seems to be lots of hesitation and discussion here about Prolia. Bosophonates were not well tolerated for me.

I had an appointment at the Mayo Clinic on July 29th.
I am still waiting for prior authorization for Evenity.

My Mayo Clinic endocrinologist's recommendation:

"I have recommended initiation of romosozumab. If this is not approved, then either abaloparatide or teriparatide would be acceptable options.

~Treatment with romosozumab would be once monthly for 6-12 months prior to transition to zoledronic acid 5 mg provided once every 12-18 months for 3 doses prior to consideration of bisphosphonate holiday.
~Treatment with either abaloparatide or teriparatide would be once daily for 12-24 months prior to transition to zoledronic acid as above."

I asked about Prolia instead of Reclast (zoledronic acid) and he said that he would not prescribe this drug. He said if I went off it my bone density would plummet. Unfortunately, I cannot recall the rest of his explanation. It was involved.

Earlier this year, I had a tele-health appointment with a metabolic bone disease doctor and his recommendation was Evenity followed by Reclast or Prolia. He said, if I understood this doctor correctly, in regards to Prolia, that I would have to be committed to it and I would probably have to take it for the rest of my life.

I have been concerned about taking Prolia because I also have Hypogammglobulinemia and my IgG levels are low. I have read that Prolia can affect the immune system. When I had a tele-health appointment with Dr. Keith McCormick he was concerned about this condition and told me to get the advice of an endocrinologist.

I am just starting my Rx bone building journey… Thanks to everyone who posts it has been very helpful.

That’s interesting news about taking Reclast every six months instead of once a year so the dose is diminished. I will definitely ask my Endocrinologist when I see him next month for my final injection of Evenity. Thanks for the information.