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Forteo before Evenity
My endo gave me a choice, without much information, between Forteo and Evenity. I have had 3 doses of Evenity. But, now I have seen that it is a preferable sequence to take Forteo, and then Evenity. Have others done this, or read about it? And, am I right in assuming it is too late to change now? I don't feel like my Endo is on top of research in general.
Thank you.
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This video, made by someone who posts here, gives a good overview of sequencing, and who might use what and in what order.
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2 ReactionsHi @aspirecreative - If you are going to sequency osteoanabolics, then yes, Forteo (or Tymlos) followed by Evenity should give the better results. That said, when you say your doctor gave you the choice, did they mean one or the other or both one after the other? It is not common to plan on two osteoanabolics unless your T-scores are pretty bad. And yes @njx58, I do talk about this is in more detail in the new 2025 version of the "New to Osteoporosis" presentation. Thanks for the reference 🙂
Here is the link https://youtu.be/OVRiiyHXeh8
If you want to share more about your T-Scores, I might be able to give a bit more feedback. And no, I do not recommend stopping Evenity at this point to switch things around.
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4 Reactions@michaellavacot I finished watching both the 2025 and 2026 versions of your new to OP presentation. My endocrinologist recommended that I start with Evenity because of the dual benefits. However, she also told me about all the other options too. But other than the primary function of each, I had to research them on my own, which led me to the community.
What I didn't expect to learn was the T before R study. So now I am second-guessing my decision to start Evenity in September. I'm sharing my DEXA findings to see if you have any input for my particular situation. I understand you are not a medical professional and will provide only your personal opinion based on the research you have read and trainings you have attended to date. I am 52F, 5' 2" 106-108 lbs. I'm in my second year of HRT (estradiol + progesterone), which I started before my OP diagnosis earlier this year.
CLINICAL DATA: Z13.820 - Screening For Osteoporosis
Patient currently takes: Vitamin D, hormone replacement therapy
FINDINGS:
BONE DENSITY MEASUREMENTS
R femur neck 03/11/2026: BMD: 0.482 T-Score: -3.30 Z-Score: -2.40
No comparisons available for R femur neck
L femur neck 03/11/2026: BMD: 0.491 T-Score: -3.20 Z-Score: -2 40
No comparisons available for L femur neck
R Total Femur 03/11/2026: BMD: 0.654 T-Score: -2.40 Z-Score: -1.80
No comparisons available for R Total Femur
L Total Femur 03/11/2026: BMD: 0.657 T-Score: -2.30 Z-Score: -1.80
No comparisons available for L Total Femur
AP Total Spine 03/11/2026: BMD: 0,733 T-Score: -2.90 Z-Score: -2.00
No comparisons available for AP Total Spine
Hi @nermar1 - I lean a lot on what I learn from Dr. Michael McClung. Looking at your numbers, he would first focus on your total hip T-Scores of -2.4 and -2.3. He does not like using femoral neck as they are too dependent on orientation during the scan. He would likely then look at your L1-L4 which is -2.9. That said, I personally still worry about the -3.3 femoral neck score as the femoral neck is the toughest to improve. The good news if that your are young and are likely at a lower risk of fracture because of your age. This buys you some time.
If you ignore the femoral neck scores, here is my take for options to consider:
1. Start with Evenity and see how you do with another DXA scan right before the end of your one year treatment to determine your next step. In one year, you would really drive down fracture risk and likely be in pretty good shape to transition into maintenance therapy of using intermittent bisphosphonates.
2. Start with Forteo or Tymlos and see how you do with another DXA scan right before the end of your two year treatment to determine your next step. These drugs will work well with your HRT treatment to give even better results. Also, if you do well, you would transition to bisphosphonate maintenance therapy and get another chunk of BMD improvement from it. More so than after Evenity.
Now if the femoral neck score worries you, after #1 or #2 above, you would likely choose long term Prolia treatment. Alternatively, you could go from #2 to #1 to squeeze everything you can out of back to back anabolic treatments. This might be very tough to get insurance to cover though.
And like you said, I'm not a doctor so work with your doctor for the best treatment for you. 🙂