Struggling with making an osteoporosis treatment decision

Posted by heyhey @heyhey, Dec 15, 2020

I am just struggling to make a decision about my treatment. I had my first bone density test and found I have osteoporosis. I have a couple of -3.2 vertebrae. My hip bones less problematic. I'm 60, active and fit. I've seen an endocrinologist and a rheumatologist who were both highly recommended. Both said "Evenity" before I barely sat down. But there is so little known about Evenity, and nothing known about its long term effectiveness or risk. I've read heart breaking posts from women who were advised to take Prolia with the same assurance and then had multiple debilitating fractures because so little was known/admitted about rebound risk. I am tearful and anxious and sleepless. I've been so healthy my body has carried me through so much life and adventure. I just don't know what to do , whether I'm putting me/my body at risk. Both doctors are paid consultants for Amgen. I feel hopeless and distressed. One of the doctors, although I said I wanted to consider my options, went ahead and got pre authorization for Evenity from my insurance "to show me how easy it would be". I feel cornered. My general doctor also has concerns about me being put on a relatively unknown drug when I haven't tried something like Forteo with a long track record.

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

@windyshores

@ericsr and @dbk67 My doc is following a bone builder (Tymlos in my case) with Reclast. He cites the issue with abrupt loss of bone density and increase in fracture risk if Prolia is stopped.

Evenity, Tymlos and Forteo build bone. Tymlos and Forteo build quality bone since resporption is not as affected, and Evenity has less effect on resorption than biphosphonates or Prolia.

My doc will follow a bone builder with Reclast. He is going to try a partial dose (1/4) due to my sensitivities, with lots of hydration and slow infusion. He told me that with monitoring I might be able to take breaks, because unlike Prolia, Reclast stays in the system.

Amgen makes both Evenity and Prolia and their website suggests Prolia after Evenity. Maybe ask your doc about Reclast instead.

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The one thing I will not consider at all are infusions after I’m done. I hope in the 12 months I’m on this something new will crop up in our journey

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@dbk67

I know how you feel. I just took my first injections yesterday. I too felt like if I didn’t do Evenity then nothing would really help me. My spine is the issue-3.6 and rest is about the same. I’m actually in need of back surgery which I can’t have. I feel this is actually a no win solution. Yes the stats say this will increase our bones in 12 months and then we must stay on something to keep them there and if we don’t then what happens? To me a no win. Constant pain and constant worry now about side effects. So My next doctor is pain management. I’ll let you know how it all goes. I think we are all up against such uncertainty in our journey with osteoporosis.

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Thanks

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@ericsr

Looking at Evenity being encouraged to do Prolia.

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I am switching from Prolia to Evenity--why--because I have experienced hair loss, hair breakage and the texture of my hair has totally changed. Also, I have lower back pain that I never had before. Once you start Prolia you are on it indefinitely, whereas Evenity is a 1-year regiment on monthly drugs.

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Thanks, that is the way i"m thinking.

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@ericsr

Osteoporosis from radiation from prostate cancer 6 years ago thinning hips. Prolia is recommended. I worry about the side effects and the 6 month dosing. Also, I read that Eventity builds bone more than Prolia.

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Good evening @ericsr, I also would like to welcome you to Connect in addition to @colleenyoung. You have legitimate questions about the products that can help with osteoporosis. I have lived through the last few years with similar "wonderments", my word for the often mysterious information about side effects.

First of all, Yes, Evenity builds bone. Prolia does not. What Prolia does is protect the bone that you have carefully built. In fact, Evenity is the only current osteoporosis medication that does both......build bone and then protect it. Here is another source for you. Evenity and Prolia are products of the same company......Amgen. If you would like, you can call them and talk to one of their team of medical professionals about your questions and concerns.

Prolia, on the other hand, does not build bone. And it is not a medication that you can stop for any reason without risking fractures. My personal experience with Prolia was rather frightening because of joint pain and some jaw pain. I asked for a consult from my endocrinologist at Mayo Clinic so that I could leave Prolia and move to a safer option.

Although previously I had reactions to bisphosphonates, he felt confident that it was because the dosage was given every six months and that large dosage was too much medication for my body to handle well. He prescribed weekly pills of alendronate and I am very satisfied with the outcome.

There are answers to be found. It does take time. Instead of Evenity I started with Tymlos and did daily injections for two years. That also worked well and I am glad that I was able to take advantage of the bone building that I received from that medication. Also, remember that Tymlos is a daily dosage....not an every six months dosage which may also work better for you.

@windyshores is also finishing her two years of Tymlos. She found the "click" option helpful. With that capability, you can start with 1 or 2 clicks and work your way up without unnecessary exposure to side effects.

Please ask any questions that you have. We have an experienced group here which can be helpful to everyone. It is all about sharing on Connect.

Is your cancer just a memory now?

May you be safe, free, and protected from inner and outer harm.
Chris

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Hi, my name is Christi. I am new here and to the osteoporisis community. I am overwhelmed like many of you. I do appreciate the candid posts in this forum and am comforted to know I am not alone. I was informed of my results less than 2 weeks ago. I was shocked. My insurance doesn't cover the BD test until the age of 65. I am 52! No history of this in my family. Like many others on this site, I live a healthy lifestyle, including exercise and diet. I rarely drink a soda or alcohol, and I have never smoked. My only 'vice' is chocolate. My OBGYN recommended Boniva (due to dosage 1X month), and my PCP prefers Fosamax due to more proven clinical results in preventing hip fractures. There is a risk of atypical fracture in taking the BPs, so I was wondering if anyone on this Forum experienced an atyplical fracture while taking BPs?
Thank you

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@artscaping

Good evening @ericsr, I also would like to welcome you to Connect in addition to @colleenyoung. You have legitimate questions about the products that can help with osteoporosis. I have lived through the last few years with similar "wonderments", my word for the often mysterious information about side effects.

First of all, Yes, Evenity builds bone. Prolia does not. What Prolia does is protect the bone that you have carefully built. In fact, Evenity is the only current osteoporosis medication that does both......build bone and then protect it. Here is another source for you. Evenity and Prolia are products of the same company......Amgen. If you would like, you can call them and talk to one of their team of medical professionals about your questions and concerns.

Prolia, on the other hand, does not build bone. And it is not a medication that you can stop for any reason without risking fractures. My personal experience with Prolia was rather frightening because of joint pain and some jaw pain. I asked for a consult from my endocrinologist at Mayo Clinic so that I could leave Prolia and move to a safer option.

Although previously I had reactions to bisphosphonates, he felt confident that it was because the dosage was given every six months and that large dosage was too much medication for my body to handle well. He prescribed weekly pills of alendronate and I am very satisfied with the outcome.

There are answers to be found. It does take time. Instead of Evenity I started with Tymlos and did daily injections for two years. That also worked well and I am glad that I was able to take advantage of the bone building that I received from that medication. Also, remember that Tymlos is a daily dosage....not an every six months dosage which may also work better for you.

@windyshores is also finishing her two years of Tymlos. She found the "click" option helpful. With that capability, you can start with 1 or 2 clicks and work your way up without unnecessary exposure to side effects.

Please ask any questions that you have. We have an experienced group here which can be helpful to everyone. It is all about sharing on Connect.

Is your cancer just a memory now?

May you be safe, free, and protected from inner and outer harm.
Chris

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Hi Chris, did you initially treat with the the BPs every 6 months and then move to the Tymlos? I am wondering about your course of treatment.
Thank you for your post.

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I think it helps to remember that osteoporosis is along a spectrum. Some have the diagnosis with a bone density of -2.6 and some are at -4.0 or worse. Treament will vary along this spectrum.

I chose Tymlos for two reasons: the dose is adjustable so I could ramp up and let my body get used to it, and I was told I could take Evenity after Tymlos but not the other way around.

I would add that without the anti-resorptive properties of biphosphonates, Prolia and to a lesser degree, Evenity, Tymlos builds quality bone. I feel much stronger after a year. But I am sure I still have osteoporotic bone density, so bone quality is important to me.

Forteo is now allowed for more than 2 years and maybe the same will happen for Tymlos. Though effectiveness is greatest for the first 6 months- a year.

I end Tymlos in April 2023. If my gains are not enough, for now, I would go on Evenity. If my gains are good on Tymlos, I will do a partial dose of Reclast (with hydration and slow infusion) and then take a break if monitoring shows I can.

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Hi there,

I was diagnosed with osteoporosis when I was in my early 60's, with a BD score of -2.4. I took Actonel for a number of years, then switched to Fosomax because when I changed insurance plans Actonel was no longer covered. The first time I took Fosomax I had a GERD reaction, and never took it again, and have taken no medication for at least the past 12 years. I'm now 79, and last year a new PCP ordered another BD test. The result was -4.0. I don't smoke or drink, I eat well and exercise quite a bit - walking, mucking for horses, and doing online bones and balance classes. My PCP recommended going back on Actonel, and had me consult with an endocrinologist who recommended one of the infusions. I did a lot of research, and decided that among other things I was unwilling to take a medication that could itself cause fractures, plus I have dental issues and compromising my jawbone etc. is not a result I'm willing to risk. It is not a given that I will ever get a fracture. I am way too medicine-averse to take any medication that, as others have pointed out, can either cause fractures or has an unproven track record. I know my decision would not be approved by many medical professionals. but I also know that the drug industry is not always to be trusted in terms of putting the welfare of patients at the top of its list of priorities, and doctors can sometimes be compromised by their relationship with pharmaceutical companies.

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