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Update Evenity followed by 2 years of alendronate

Posted by hikernurse @hikernurse, Oct 25, 2025

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 🙏

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rola | @rola | 3 days ago
In reply to @hikernurse "@rola qt16609 This is the test code for quest that i used. 16609. It was $80...." + (show)
Profile picture for hikernurse @hikernurse

@rola
qt16609
This is the test code for quest that i used. 16609. It was $80. The CTX is usually $50. I’m glad the Evenity is working for the second time. I surely was very compliant with the alendronate both years that I took it and was shocked with the second year results as I still do all the right things. But definitely the start of the second Evenity was a bit rocky as I had foot surgery and wasn’t able to lift or exercise much for a couple months. I will keep posting as I’ve learned so much and a bit shout out to mayblin for her help

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@hikernurse

TY for the code, and yes, mayblin's posts are so very helpful this is a great forum. I don't doubt for one second you had not adhered to the protocol. I did wonder if the rebound was as severe compared to Prolia, but after reading up, that's not at all the case, thank God! I'm not tolerating the Alendronate and am looking to rule out other issues before dealing with that aspect.

Thanks again, best wishes on moving forward.

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debhatchell | @debhatchell | 3 days ago
In reply to @hikernurse "@mayblin I did just have another DXA and Spine improved to -1.4. FN lost a tiny..." + (show)
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@mayblin
I did just have another DXA and Spine improved to -1.4. FN lost a tiny bit of BMD .007 (.625 ➡️ .618 keeping me at -3.0) but total femur increased slightly (.642 to ..674) -2.8–2.6 T-scores

PINP was 44 and CTX decreased a bit to 416 and vitamin D 49.
I think this all says Evenity is still working and I fortunately have no side effects. I’ve now completed 7 months of the second course.
Thinking very possibly as you suggested the bunion surgery and period of less activity post op likely contributed to higher CTX.
Plan to repeat PINP/CTX in 3 months. (thank you Jason Health). Endocrinologist said ‘Evenity still working, complete course’
Next hurdle will be Reclast vs Prolia (maybe just one injection followed by Reclast)
As much as I would love getting some type of HRT I do not think anyone will prescribe. Mom passed from Cerebral hemorrhage and I do have occasional migraine with aura. Although I still think I’m very low risk! Appreciate any thoughts.

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@hikernurse Thank you for sharing. Do you mind if I ask what your starting DEXA numbers were? I'm -4.0. I just had my 10th Evenity injection. Deciding between Prolia and Reclast. My crappy (and soon to be ex) doctor said Im so bad doing a follow-up Dexa is a waste of resources. Yes, he said that.

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kristie2 | @kristie2 | 2 days ago
In reply to @hikernurse "@mayblin I did just have another DXA and Spine improved to -1.4. FN lost a tiny..." + (show)
Profile picture for hikernurse @hikernurse

@mayblin
I did just have another DXA and Spine improved to -1.4. FN lost a tiny bit of BMD .007 (.625 ➡️ .618 keeping me at -3.0) but total femur increased slightly (.642 to ..674) -2.8–2.6 T-scores

PINP was 44 and CTX decreased a bit to 416 and vitamin D 49.
I think this all says Evenity is still working and I fortunately have no side effects. I’ve now completed 7 months of the second course.
Thinking very possibly as you suggested the bunion surgery and period of less activity post op likely contributed to higher CTX.
Plan to repeat PINP/CTX in 3 months. (thank you Jason Health). Endocrinologist said ‘Evenity still working, complete course’
Next hurdle will be Reclast vs Prolia (maybe just one injection followed by Reclast)
As much as I would love getting some type of HRT I do not think anyone will prescribe. Mom passed from Cerebral hemorrhage and I do have occasional migraine with aura. Although I still think I’m very low risk! Appreciate any thoughts.

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@hikernurse I have chronic migraines and BHRT was no problem.

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hikernurse | @hikernurse | 2 days ago
In reply to @debhatchell "@hikernurse Thank you for sharing. Do you mind if I ask what your starting DEXA numbers..." + (show)
Profile picture for debhatchell @debhatchell

@hikernurse Thank you for sharing. Do you mind if I ask what your starting DEXA numbers were? I'm -4.0. I just had my 10th Evenity injection. Deciding between Prolia and Reclast. My crappy (and soon to be ex) doctor said Im so bad doing a follow-up Dexa is a waste of resources. Yes, he said that.

Jump to this post

@debhatchell
In 2022 my first DXA at age 65 was spine -3.1 and FN -3.3 and I severely fractured wrist needing surgery from a fall while hiking. I had previously fractured the other wrist 10 years prior from flying off the stairs in a new house. Stairs were curved and I missed the last few so it was quite traumatic. That bought me Evenity and got me on this site and a deep dive into Keith McCormicks book Great Bones.
And yes your Dr is very wrong to say that. If I had waited after my second year of alendronate to find out that it wasn’t holding my gains I would have been in much worse shape. So far I’ve had no problem having annual DXAs covered except for this last one that was pushed by me because of a CTX higher than I thought it should be (489). I might have to pay for that one out of pocket. I have certainly learned if the doc doesn’t order bone turnover markers you can through Jason Health to do it and always pair CTX with PINP. Just another piece of the puzzle. And we are all so different. I’ve often thought if the docs spent a couple days reading some of these posts they’d be so much better treating all
of us I feel as I can say this because my husband is a now retired internist and he’s learned much. it is a complicated disease.

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debhatchell | @debhatchell | 2 days ago
In reply to @hikernurse "@debhatchell In 2022 my first DXA at age 65 was spine -3.1 and FN -3.3 and..." + (show)
Profile picture for hikernurse @hikernurse

@debhatchell
In 2022 my first DXA at age 65 was spine -3.1 and FN -3.3 and I severely fractured wrist needing surgery from a fall while hiking. I had previously fractured the other wrist 10 years prior from flying off the stairs in a new house. Stairs were curved and I missed the last few so it was quite traumatic. That bought me Evenity and got me on this site and a deep dive into Keith McCormicks book Great Bones.
And yes your Dr is very wrong to say that. If I had waited after my second year of alendronate to find out that it wasn’t holding my gains I would have been in much worse shape. So far I’ve had no problem having annual DXAs covered except for this last one that was pushed by me because of a CTX higher than I thought it should be (489). I might have to pay for that one out of pocket. I have certainly learned if the doc doesn’t order bone turnover markers you can through Jason Health to do it and always pair CTX with PINP. Just another piece of the puzzle. And we are all so different. I’ve often thought if the docs spent a couple days reading some of these posts they’d be so much better treating all
of us I feel as I can say this because my husband is a now retired internist and he’s learned much. it is a complicated disease.

Jump to this post

@hikernurse Oh, THANK YOU for your lovely response. You've just opened up a whole new world to me. I had not heard of Keith McCormick's book or Jason Health. NOR had the doc ever mentioned bloodwork. I'm a data-person and want to measure everything. Besides the DXA that showed my weakest point being the -4.0 (spine and forearms) last year, nothing has been done. Zero bloodwork. This information makes me even more shocked at the negligent level of care I've been receiving.

I'll get some labs ordered; gratefully I have an integrative medicine doc who will order any test I want. I'll pick up Great Bones and start reading. I called my insurance company and they confirmed that under my plan, one annual DXA scan is considered preventative and are covered. But, like you, I'd be willing to pay out of pocket to know.

Thank you, sweet angel. I truly appreciate these tips.

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