2 fractures and which drug best to start.

@brendammc Welcome to Mayo Clinic Connect.

What does your doctor recommend? Are you seeing your primary care physician or endocrinologist or rheumatologist for osteoporosis? I see an endocrinologist who prescribed 12 months of Evenity injections (monthly) and then a Reclast infusion. The Evenity was to build bone density and my bone density scan showed significant gains in my hip and lower back. I had no side effects other than a little soreness at the injection site. The Reclast infusion was meant to "lock in" the gains in bone density. I did not have any side effects from the Reclast infusion.

@brendammc Welcome to Mayo Clinic Connect.

What does your doctor recommend? Are you seeing your primary care physician or endocrinologist or rheumatologist for osteoporosis? I see an endocrinologist who prescribed 12 months of Evenity injections (monthly) and then a Reclast infusion. The Evenity was to build bone density and my bone density scan showed significant gains in my hip and lower back. I had no side effects other than a little soreness at the injection site. The Reclast infusion was meant to "lock in" the gains in bone density. I did not have any side effects from the Reclast infusion.

@brendammc An anabolic promotes muscle tissue although over time too much anabolic in the form of steroids increases the risk of osteoporosis. The objective for me was to build bone density not muscle tissue. I was and am building and maintaining muscle through weightlifting.

I had taken alendronate sodium (Fosomax) for 5 years. While I was on alendronate I did not have any fractures and was no longer in the osteoporosis range at that 5 years mark. Then, I had pelvic radiation in 2021 for a recurrence of endometrial cancer and my radiation oncologist told me that pelvic radiation can affect bone density. In early 2023 when I had a CT as a part of my routine cancer surveillance appointment a sacral fracture was discovered. So then that started the path to endocrinology. The endocrinologist told me I was already doing everything possible on my own for osteoporosis through diet and exercise. That sacral fracture meant that it was now time to consider medication along with all the other things I was doing. Because of my cancer history Prolia was not indicated (one of the warnings of Prolia is history of cancer) so Evenity was the next best choice. I followed my endocrinologist's recommendation and took the monthly Evenity injections to build bone density.

Does that answer your question "Can you tell me why you went on Evenity cp to an anabolic?"

I am not sure if the video above discusses the different classes of medication used in osteoporosis but to summarize, there are basically three:

1. Bisphosphonates which slow or suppress bone metabolism. This includes both bone breakdown and bone building. If you have already fractured, taking a bisphosphonate may help prevent additional fractures but it's clear that your bones are already fragile. Bisphosphonates include alendronate (Fosamax), zolendronate (Reclast), risendronate (Actonel), and ibandronate (Boniva). These can be taken orally or intravenously.
2. Parathyroid hormone replacement drugs which encourage bone metabolism, including both bone breakdown and bone building. This class of medication may help you replace the fragile, degraded bone that you have and provide additional protection against fractures. There are two currently in use: teriparatide (Forteo) and abaloparatide (Tymlos). Both require daily injections over a two-year period.
3. Monoclonal antibodies which also work on bone metabolism. These also impact bone breakdown and building. The two that are used are denosumab (Prolia) and romosozumab (Evenity). These are injections that are given every 6 months (Prolia) or every month (Evenity).

The last two are considered anabolic in nature because they encourage the production of new bone.

With two fractures, you would be considered as having severe osteoporosis and that makes you a candidate for an anabolic medication (#2 or #3).

Taking a bisphosphonate first may reduce the effectiveness of an anabolic medication taken later. This is why the expert consensus recommends using an anabolic medication first.

I was on Fosamax for over five years and had a fracture just after the five-year mark. I've been on a series of anabolic medications (Tymlos, then Forteo, and now Evenity) for just over a year. It's unknown at this point how effective this will be for me since my bone metabolism was suppressed by the Fosamax for so long. I will find out next year after my Evenity treatments are finished.

A specialist can guide you best in which anabolic is best. Evenity does carry a risk for people with cardiac issues while the PTH replacement drugs have side effects that can be untenable.

I am not sure if the video above discusses the different classes of medication used in osteoporosis but to summarize, there are basically three:

1. Bisphosphonates which slow or suppress bone metabolism. This includes both bone breakdown and bone building. If you have already fractured, taking a bisphosphonate may help prevent additional fractures but it's clear that your bones are already fragile. Bisphosphonates include alendronate (Fosamax), zolendronate (Reclast), risendronate (Actonel), and ibandronate (Boniva). These can be taken orally or intravenously.
2. Parathyroid hormone replacement drugs which encourage bone metabolism, including both bone breakdown and bone building. This class of medication may help you replace the fragile, degraded bone that you have and provide additional protection against fractures. There are two currently in use: teriparatide (Forteo) and abaloparatide (Tymlos). Both require daily injections over a two-year period.
3. Monoclonal antibodies which also work on bone metabolism. These also impact bone breakdown and building. The two that are used are denosumab (Prolia) and romosozumab (Evenity). These are injections that are given every 6 months (Prolia) or every month (Evenity).

The last two are considered anabolic in nature because they encourage the production of new bone.

With two fractures, you would be considered as having severe osteoporosis and that makes you a candidate for an anabolic medication (#2 or #3).

Taking a bisphosphonate first may reduce the effectiveness of an anabolic medication taken later. This is why the expert consensus recommends using an anabolic medication first.

I was on Fosamax for over five years and had a fracture just after the five-year mark. I've been on a series of anabolic medications (Tymlos, then Forteo, and now Evenity) for just over a year. It's unknown at this point how effective this will be for me since my bone metabolism was suppressed by the Fosamax for so long. I will find out next year after my Evenity treatments are finished.

A specialist can guide you best in which anabolic is best. Evenity does carry a risk for people with cardiac issues while the PTH replacement drugs have side effects that can be untenable.

That's a nice breakdown, oopsiedaisy. One small tweak: denosomab (Prolia) is classed as anti-resorptive, since it boosts BMD by preserving existing bone and allowing secondary mineralization, rather than truly building new bone.
https://pmc.ncbi.nlm.nih.gov/articles/PMC3549483/#:~:text=Almost%20all%20pharmacological%20agents%20for,increases%20(11%E2%80%9313).