Switching from Prolia to Evenity

Posted by olk @olk, Mar 25 5:04pm

I have been on Prolia for 4 years, and thought have had small improvement , my new Endo suggests I try Evenity for the next year.
My concern is how to time the switch.
If I stop the Prolia which is due in 3 weeks, will the Evenity be enough to counteract the rebound from the Prolia.
Also, if I have a bad reaction to the Evenity, can I just immediately switch back to Prolia.
My dr. is out of town, and I also await answers to these questions!
p.s. prior to starting Prolia I had 3 compression fractures.

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

gently | @gently | Mar 25 9:27pm

olk, the research is mixed on whether Evenity can prevent rebound from Prolia. The risk is greater after 2+ years on Prolia. I wouldn't take that risk.
Prolia stops the maturation of osteoclasts(the cells that break down bones) at the very last stage. Evenity blocks sclerostin which prevents the development of new osteoclasts. When you stop Prolia the very large collection of osteoclasts in the very last stage of maturation, mature rapidly and are unleased on your bones. By mechanism, Evenity cannot stop them. An additional problem with the four year reservoir of osteoclasts is that they combine with other osteoclasts and to become large bone eating cells. Some have multiple compression fractures called cascade fractures one after the other.
Reclast the strongest protection against rebound might be something to consider. It has some drawbacks as far as side effects, so you'd want to look a the literature on this site carefully before deciding. You could switch back to Prolia after the first month if you had a bad reaction to Evenity.
I'd rather see you add Forteo to the Prolia for the next six months and then take a lower 4mg dose of Reclast with a long (one hour) infusion.
You might ask for bone markers. They can save us the pain and cost of medications that aren't effective for us.
I hope you get many different responses to mull over for the next three weeks.
Welcome to Connect and
Bless your bones.

daylemaples | @daylemaples | Mar 26 3:04pm

be VERY careful stopping Prolia. be sure your doctor is checking bone markers ( beta CTX and P1NP) regularly and frequently beginning 4 months ( not 6 mos … rebound can start early ) after last dose of Prolia. I your doctor doesnt have a clear strategy. get a doctor who is all over this rebound and how to stack therapies if needed to stop it.
Reclast is my choice after much research and consultation.