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Undecided choice of drugs for Osteoporosis
Osteoporosis & Bone Health | Last Active: 4 days ago | Replies (363)Comment receiving replies
Reclast at 20% or Evenity for the first three months for the strongest effect. Clever.
I'm looking at the cardiac risks for Evenity. The black box and the uncertain role of sclerostin.
But you are tempting me with this three months.
One of the really smart docs I've been talking to thinks that the risks were artifically elevated because the drug used in the control arm reduces cardiac risk. And, "A meta-analysis of randomized controlled trials suggested that administration of the sclerostin blocking antibody romosozumab did not significantly increase the risk of major adverse cardiovascular events (risk ratio, 1.14 [95% CI, 0.83-1.57]; P=0.54) or cardiovascular death (risk ratio, 0.92 [95% CI, 0.53-1.59]; P=0.71). Human genetic studies reported variants predisposing to low arterial sclerostin expression were associated with a high risk of cardiovascular events. Overall, past research suggests a cardiovascular protective role of sclerostin but findings have been inconsistent, possibly due to variations in study design, the unique populations and models studied, and the heterogeneous methods used."
https://pubmed.ncbi.nlm.nih.gov/35546488/
I have the idea mainly from the Tower studies that we may be over medicated with Forteo and alternate dosing could open the metabolic window. My real plan is to follow the bone markers. I'll break from Forteo when the balance of osteoblast/osteoclast is compromised in favor of the clasts or just in equilibrium. I think I'll be able to repeat Forteo after a month or two of nothing and then resume and quit based on the markers.
Cardiac disease is the number one cause of death, the one cause most of us will die from. So I'm cautious about Evenity.
Replies to "Reclast at 20% or Evenity for the first three months for the strongest effect. Clever. I'm..."
I was concerned about the increased risk of stroke and heart attack also. Both my rheumatologist and my endocrinologist wanted me to go on Evenity. So, I went to my cardiologist and he ran some tests. No issues. I went to my neurologist and he ordered an mri of my brain and an ultrasound of the carotid arteries. No blockages. So, I embarked on my Evenity journey. I’m halfway done as I just had sixth injections. No side effects.
I do realize that no one knows what the long term side effects might be.
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I rarely did a full dose of Tymlos and still had huge gains for spine and good gains for hip. I like adjustable meds! I asked about having one shot of Evenity versus two for my first but no go.
My doc did not recommend Evenity after Tymlos but wrote "thank you for your persistence" and agreed. Funny doc, and really works with me.
The 20% Reclast dose is a test dose and after a month I am to tell my doc how I fared and tell him what dose I want next. I read that a half dose is as effective as full dose- can't cite right now- and I am small. McCormick suggested I just keep doing 20% but if I handle it I will try 2mg (40% dose). But after whatever time I do Evenity.
I am not worried about Evenity and the lack of sclerostin short term. I read there were two studies. When compared to placebo, Evenity's risk of cardiovascular events was equal. But when compared to alendronate, Evenity fared worse (not a huge difference) and it was speculated that that was because alendronate had a protective effect. Still, the role of sclerostin does seem potentially important for health.
Evenity becomes more anti-resorptive over the year and is mainly a bone builder for the first 3-6 months (I have been told 3. 4.and 6 months by different professionals. So yeah, thinking about a shorter term course.
I have afib so ironically Reclast is riskier for me than Evenity. I'll post about how I handle Evenity. I am sensitive to everything so if I do okay, it should be reassuring!