Reclast affect on Evenity ?

Posted by 255anny @255anny, Sep 9, 2024

I see my Endo Dr. Wednesday. Hopefully I can resolve this drug issue and move on. I have one question. It has been brought up in our discussions, but I'm wondering if any of you can expand on it a bit further. If I have the 1 infusion of Reclast and the plan is to follow that with 1 yr. of Evenity, do you begin the Evenity 12 months after the Reclast infusion? I seem to remember some mentions that the Reclast is so strong it might blunt the Evenity. If this is so, then would the start of the Evenity be delayed further out than the 12 month mark from the Reclast infusion? Do you need bone markers to measure this?

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Profile picture for mayblin @mayblin

Hi @255anny attached are graphs from a 2022 review paper by Dr. F Cosman regarding romosozumab (Evenity) and antiresorptive treatment sequencing. Although alendronate (Fosamax) was the bisphosphonate used in the studies, you can see prior treatment of alendronate, a bisphosphonate, does attenuate the effects of evenity to certain degree - as shown with the orange bars in the graphs on the left. I know we can’t simply extrapolate the results to reclast, however, this might give us some ideas and may provide a discussing point with the doctor.

Regarding bone turnover markers, it depends what the treatment(s) will entail. Reclast does not have bioavailability issues like fosamax, a standard dose of iv 5mg should get your osteoclasts suppressed hence a pretty low CTX. If in case your endo is going to do some treatment variations, then I think it’s worth to do them. For example, if you and your endo want to monitor how you are going to respond to the second round of evenity in the future (other than the dexa scan in the end), s/he might want to monitor bone markers along the way and watch trends. Also, in case your future round evenity won’t be approved by insurance and your endo wants to time next dose of Reclast, then you need to know your CTX level.

There could be times when we don't really know what next step will be, not testing bone markers means we miss info along the way. I didn’t have my baseline bone markers done and I will never have that info. But currently my endo is monitoring my bone markers on a regular basis in order to adjust my HRT dose accordingly if needed.
https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html

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Thank you. I'm hoping my visit with her answers some of my questions 🙂 But this will be a short appt, so we shall see.

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Profile picture for 255anny @255anny

Thank you. I'm hoping my visit with her answers some of my questions 🙂 But this will be a short appt, so we shall see.

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Here is an article on bone markers (and chornic kidney disease)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628199/
and an excerpt:
For these reasons, especially in CKD, it is important to realize that estimating bone turnover by measuring circulating biomarkers is full of pitfalls, that even a reliable estimate of turnover does not indicate changes in bone balance, and that fracture risk is also dependent on bone features that cannot be assessed by biomarkers, nor even by bone histomorphometry like architecture and bone strength

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Profile picture for 255anny @255anny

I am finishing my first course of Evenity this month. (prior to that I was on Forteo, 2ys)
My Dr was suggesting I now transition to 1 yr of Prolia, then return to Evenity. I'm not comfortable with that medication sequence.
So my thoughts now are transition to Reclast for 1 yr. then return to Evenity, if possible.

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@255anny I thought Evenity was only ever allowed for one year and that was it forevermore. Did you hear otherwise? I finished Evenity and now looking at starting Reclast or Prolia and wondering if that means I can never go back to Evenity. Any insights you have appreciated!

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Profile picture for mayapath2health @mayapath2health

@255anny I thought Evenity was only ever allowed for one year and that was it forevermore. Did you hear otherwise? I finished Evenity and now looking at starting Reclast or Prolia and wondering if that means I can never go back to Evenity. Any insights you have appreciated!

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@mayapath2health
I was led to believe that evenity was a one year only. Not to be repeated. That is what I did and now probably doing reclast which is my doctors choice for me.

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Profile picture for mayapath2health @mayapath2health

@255anny I thought Evenity was only ever allowed for one year and that was it forevermore. Did you hear otherwise? I finished Evenity and now looking at starting Reclast or Prolia and wondering if that means I can never go back to Evenity. Any insights you have appreciated!

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@mayapath2health Have you been told what the acceptable gap time is between finishing Evenity and starting Reclast? Thanks so much.

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Profile picture for susanjohnston @susanjohnston

@mayapath2health Have you been told what the acceptable gap time is between finishing Evenity and starting Reclast? Thanks so much.

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@susanjohnston Endo office that administered Evenity recommends I start either Prolia or Reclast at 4 weeks. Not sure if that is standard or not.

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Profile picture for mayapath2health @mayapath2health

@susanjohnston Endo office that administered Evenity recommends I start either Prolia or Reclast at 4 weeks. Not sure if that is standard or not.

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@mayapath2health Thanks so much.

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Profile picture for gently @gently

255anny,
Evenity's effect may be blunted by prior use of Reclast, but it will increase bone density after Reclast. The deposition of bone with Evenity is almost all modeling which doesn't involve the osteoclasts that are efficiently blunted by Reclast. Evenity's mechanism of action is different than the bisphosphonates as it increases the number of osteoblasts.
You might advantage the measured effect of Evenity by delaying treatment, but the delay wouldn't advantage the total effect on your bones.
Some doctors say that one year of Reclast has the same effect at two years as two consecutive years of Reclast.
You'd have additional fracture risk prevention if you had the Evenity injections after the first year of Reclast.
If you were at high fracture risk, you might not want to wait that extra year.
Bone markers are always wise. I'd have them before, and at three months.

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@gently I see this is from a year ago but I’m hoping you wouldn’t mind expanding. If I did Reclast for one year before Forteo or possibly Evenity is that a better route than straight to Forteo? ( I couldn’t tolerate the alendronate. )So I guess I’d know if I could tolerate the Reclast when also needed for a relay drug. I have very low bone density in spine (-4.5) with fractures so want to do the best possible way.
Thanks for any input from the wise folks on this site.
I see the specialist in a week.

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brendammc,
the low bone density would make Evenity a consideration. It adds bone the most quickly and could give you a scaffolding effect protecting you from fracture. Personally I would go straight to Forteo, even so. But think you should give Evenity a thought considering where you've fractured and looking carefully at the accuracy of the -4.5.
Each of these drugs create a different quality of bone
Forteo just creates the best bone, the strongest and most resilient. It is one of the two medications that reconstruct the cartilage structure in the spinal vertebra. Fracture protection begins more quickly than bone density with Forteo use.
Evenity increases bone density the fastest. And it is amazing. The bone lain down is heavier without the communication channels that make integrative bone. It doesn't repair the inner layer of bone, but lays the bone on (against) the outside of existing bone. It's only tempting to me where the bone is likely to fracture very soon.
I wouldn't consider Reclast because it is just too slow. It builds bone by collecting it over time. I like that it protects against further loss, but it can't repair older fissured bone,.
The mechanism of both Reclast and Evenity prevent the repair of bone that I think you need at -4.5.

Another complication with Evenity is what do you take after it, because that bone is lost within a year.
Some few are taking a second year of Evenity. Others are following with Reclast and, of course, Amgen wants you to take Prolia.
Some agile doctors are prescribing Tymlos following Evenity which seems (from individual reports here) to be maintaining the Evenity-bone.
Remember though that I'm just a fellow traveler without the scientific background of our doctors. I hope that the truly wise will contradict me. And hope that you feel free to contact me.
Blessing your choice.

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Which one of these can cause kidney issues?

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