My Experience on Evenity for Treating Osteoporosis

I have been on Evenity for 7 months and had few side effects. The endcrinologist is recommending Prolia when I go off Evenity. I am looking for alternatives and considering HRT (Hormone Replacement Therapy) to stop on-going bone loss. I am 76 and have had one broken bone prior to Evenity with a DEXA score of -2.67. Has anyone had any experience with HRT for bone loss after the age of 60?

@lbmorgan44 Have you considered Reclast instead of Prolia? The same company, Amgen, makes Evenity and Prolia so it seems a lot of folks are doing that combo. But you cannot just stop Prolia, because there is a quick drop in density when you do, according to doctors I know. On the other hand, Reclast may be able to be given in a partial dose and with proper monitoring, can be stopped and then started again when needed. Again that is what my doc said. Your bone density score is not that bad- just over the line of osteoporosis. Are they sure you broke that bone because of osteoporosis?

From the Mayo Clinic (excerpted) on risks of HRT - scroll down for risks over 60.
https://www.mayoclinic.org/diseases-conditions/menopause/in-depth/hormone-therapy/ART-20046372
What are the risks of hormone therapy?
In the largest clinical trial to date, hormone replacement therapy that consisted of an estrogen-progestin pill (Prempro) increased the risk of certain serious conditions, including:

Heart disease
Stroke
Blood clots
Breast cancer
Subsequent studies have suggested that these risks vary depending on:

Age. Women who begin hormone therapy at age 60 or older or more than 10 years from the onset of menopause are at greater risk of the above conditions. But if hormone therapy is started before the age of 60 or within 10 years of menopause, the benefits appear to outweigh the risks.
Type of hormone therapy. The risks of hormone therapy vary depending on whether estrogen is given alone or with progestin, and on the dose and type of estrogen.
Health history. Your family history and your personal medical history and risk of cancer, heart disease, stroke, blood clots, liver disease and osteoporosis are important factors in determining whether hormone replacement therapy is appropriate for you.

ps I have had hormone-driven breast cancer so cannot do HRT anyway...

Thank you for your well thought out reply.

I have considered Reclast. However, I was unable to tolerate Fosamax which is also a bisphosphonate.

Prolia has significant side effects and with the possibility of multiple spinal fractures when you go off of it in 3 to 5 years, I am inclined to avoid that medication.

There do not appear to be any studies showing whether repeating annual doses of Evenity will produce bone growth.

That leaves hormone replacement therapy (HRT), which has its own consequences as you pointed out.

All treatment options have consequences. I am weighing quality of life versus quantity of life as I look over all options.

Take care and thank you for your reply.

Was GERD the problem with Fosamax? Reclast at least doesn't cause that. As I wrote, my doc said if the current med brings enough improvement, Reclast could be given as a partial dose, things could be monitored, and unlike with Prolia, you can take a break.

What about Tymlos or Forteo.

I have no genetic risk for breast cancer and sometimes blame my few months on HRT for my estrogen-driven cancer. But that isn't really fair. Still, they don't seem to prescribe it for over 60. Maybe Evista?

I know you didn't ask for another response, but I can't help myself sometimes 🙂

It was severe joint, muscle and bone pain that caused me to discontinue Fosamax. Reclast is a bisphosphonate and can cause the same side effects as Fosamax. I am reluctant to take Reclast because of that.

Are you considering Tymlos or Forteo as well?

Hi, I'm Connie, 74 yrs. old & have severe Osteoporosis. Fosamax wasn't working well enough and was suggested I go on Evenity for one year then they'll give me the IV reclast. Evenity has a big side effect of "Strokes" which is a huge concern. I have a healthy heart, so why do I want to risk my heart health? But do I want to risk falling and shattering a hip? So I've elected to try Evenity. I'm trying to be positive, but don't want to spend a year worrying about heart failure at some level. I'm glad I found this blog, other people's thoughts have eased my mind. Also, I'm having further conversations with my endocrinologist to see how they're going to monitor me throughout the year; a little hand holding will help....plus a lot of prayers. Thank you

I am currently on Evenity which is in the same drug group as Tymlos and Forteo. I have read that Evenity is approved for use after Forteo or Tymlos; however, once Evenity is administered, you cannot go on Tymlos or Forteo.

My Endocrinologist is recommending Prolia after I complete the one-year course of Evenity. Prolia blocks the resorption of bone and will help retain the bone that is created from the use of Evenity. Note that Prolia also slows the entire bone remodeling process. Clinical trials for Prolia are 3-4 years long and it "might" be safe up to 8 years according to Mayo Clinic. Since Prolia does not build bone, when it is stopped there is a more rapid breakdown of bone which increases the risk for spinal fractures. After reading the negative reports on Prolia I am reluctant to take it.

What about going back on Evenity/Tymlos/Forteo after Prolia? The book Mayo Clinic on Osteoporosis by Anne Kearns, M.D., Ph.D. on page 163 states that taking Evenity/Tymlos/Forteo after stopping Prolia can be associated with limited improvements in bone density or even bone loss. It seems to me that going ON Prolia has significant consequences. Then going OFF Prolia becomes a dead end, at least for me.

Going on Prolia, for me, will give me a few quality years IF I have no side effects. Since there is nothing I can take when I go off of it, and bone loss is a given when going off Prolia, why would I take it in the first place?

What are the next choices and consequences when Prolia is no longer an option and I cannot tolerate the bisphosphonates (Fosamax and Reclast type drugs) and Tymlos Forteo and Evenity are also not options?

I am researching estrogen and estrogen-related medications to treat osteoporosis. There is Raloxifene/Evista in a class of drugs called Selective Estrogen Receptor Modulators (SERMs). This medication is supposed to improve bone density and prevent spinal fractures. It is not as effective on hips and wrist fractures. A drug called Duavee is in a different classification of drugs and helps maintain bone density and reduces the risk of fractures. It is used primarily to prevent osteoporosis, but not treat it. The risks of hormone therapy are lower for younger women than for those age 60 or older. These two estrogen-related medications carry the risk of deep vein thrombosis (DVT), blood clots in lungs and strokes.

I have always been active, eaten a well-balanced diet and have been taking calcium, Vitamin D along with other supplements as I watched my DEXA scores drop. Osteoporosis has no cure and all categories of mediations to stop bone loss or build new bone present their own challenges and significant consequences and have a limited timeframes for usage.

What I am seeking is quality of life, not longevity. Choosing from narrowing treatment options is also choosing how my final years will be spent. All choices have significant consequences. Given that, I can only make the best decision for my situation. I have a few more months of research before the year-long treatment of Evenity is completed and a decision must be made for the next step.

I plan to continue to post any information I find that has been well researched and might be helpful for those of us trying to make difficult decisions about our health.

You are very knowledgeaboe @lbmorgan44 . Small point but technically Evenity is not in the same med group as Tymlos or Forteo, which work through the parathyroid. Evenity suppresses protein called sclerostin, and it also suppresses bone turnover, though to a lesser degree than biphosphonates and Prolia. Tymlos and Forteo do not suppress bone turnover.

I am hoping to follow Tymlos with Evenity and then a partial dose of Reclast with lots of hydration. I also could not tolerate Fosamax. I don't want to go on Prolia because of the drop off when stopped and also possible effects on the immune system, though it seems to be mainly in the skin.

Windyshores, thank you for your comments on the difference between Tymlos, Forteo and Evenity . All three medications boost bone formation and is the reason why I place them in one group. I believe it is good to have information around how these medications use different pathways to achieve results.

Overtime our bones require a balance between forming new bone and the breaking down and removing of old bone (resorption). Sclerostin, which increases with age, leads to bone loss and reduced bone strength and inhibits bone formation. Evenity blocks sclerostin. When this happens new bone is built more than the loss of bone. In addition Evenity reduces bone resorption thus increasing the bone mineral density (BMD). Evenity has a very different pathway for increasing bone density than Forteo and Tymlos.

Forteo and Tymlos use a Parathyroid Hormone (PTH) to activate bone-creating cells called osteoblasts which create new bone cells. Forteo and Tymlos do not slow the resorption of older bone.

Bisphosphonates (Fosamax, Boniva, Reclast) effect the bone resorption cells called osteoclasts. These cells absorb the bisphosphonate medication. The rate at which bone cells are broken down is slowed thus slowing bone loss.

I hope this give more clarity as to how these medications work inside the body. Thanks again for your comments. Every idea sends me on a deeper dive into how this all works. I find it reassuring to have more knowledge than less.