← Return to Is tymlos or evenity better for osteoporosis

Discussion
Comment receiving replies
Profile picture for cbusgma2017 @cbusgma2017

@osteopatient2026
This was my question for @gently (that is, what are your sources for Tymlos making better bone than Evenity).

@gently responded with a link to an article in nature.org entitled "Bone remodeling: an operational process ensuring survival and bone mechanical competence". You can google it
(I am apparently too new a member of this community to post the actual link).

I'm still working on understanding the article (it's very technical).

Jump to this post


Replies to "@osteopatient2026 This was my question for @gently (that is, what are your sources for Tymlos making..."

@cbusgma2017
At the most basic level you can't remodel bone without osteoclasts. Evenity works primarily by blocking osteoclasts just like the bisphosphonates and Prolia, all three by different methods.
We've come to think of osteoclasts--the cells that break down bone as the enemy. But osteoclasts don't break down bone at random. They are attracted to sites where the bone is weak, damaged, fissured. (As much as I dislike metaphors) you would never wax your floor or your car without cleaning it first. Medications that block the osteoclasts are doing just that to your bones. Leaving damaged portions underneath the new fresh bone. Those damaged portions have lost vascular and nerve viability. So you have encased in the new bone the potential for osteonecrosis.
Chrondrocytes need sclerostin for maintenance and development. Chondrocytes necessary for the production of collagen. Because the PTH drugs increase the production of chondrocytes they are able to rebuild the cartilaginous pre-structures that are needed to replace lost trabecular bone. Evenity blocks sclerostin.
Within joints you lose also lose the extracellular matrix for maintenance joint function. Without sclerostin, cartilage becomes bone in the form of bone spurs.
Evenity does add bone between the periosteum and the endosteum. Sometimes where there had never been bone before. Heavy thick bone and if you measure strength by density alone, you'll believe heavier is stronger.

But the whole purpose of osteoporosis medications is to prevent fracture. And all of these medications are effective for some and ineffective for the few.