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Evenity Advice?
I am 66 years old and have been on Reclast for two years with some improvement in my scores, although the second year my spine score went down. My endocrinologist at Mayo Clinic discussed Evenity and Tymlos and I think I am going to try Evenity since it is one year and convenient to go once a month to the clinic to get the injections. I had concerns about the black box warnings regarding heart attack and stroke, but she reassured me that she has not heard of anyone experiencing this. I also have an appointment with my cardiologist to see what he says before I start. I don’t know what else to do and yes, I’m very nervous about taking this drug, but I know it’s supposed to give me big gains in my spine where I need it the most. Any additional advice?
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Let me see if I understand...
Tymlos/Forteo build bone density. But, you can only take them for a limited time. If you still need/want to build more bone density after that, then you need to continue with another drug, like Prolia or Evenity. There's a big rebound risk with Prolia, so idealy you don't want to be on it too long, and preferably you can avoid it altogether?
Then, you need something like Reclast or Fosamax to lock in gains that would otherwise be lost?
Is there a point where you can stop taking meds, depending on what DEXA result the doctor deems acceptable to live with?
I was faced with the same situation as you. I was on Evenity for a year and now Prolia for 2-3 injections and then onto Reclast. The Prolia can increase your bone density further and then reclast to lock in the gains.
How long after Evenity is he having you start with Prolia?
I am not sure about the "lock-in" gains using Reclast. I had 3 years of Reclast and then stopped it when my bones had improved. Ten years down the road, my spine was horrible! -4.5! I had 2 more years of Reclast and now I am on Evenity. I am not eager to use Reclast again. I blame it for a loss of my kidney function. Osteoporosis is currently not curable. It is manageable by always using different drug treatments.
@pami you had 7 years without meds, is that right? So I don't think any doctor had told me that a long drug holiday like that is in the cards for me. My understanding is that over that time Reclast tends to dissipate, and the "locking in gains" applies to short term prevention of rebound from stopping other drugs. But I could be wrong: It does seem there is an expectation from doctors that Reclast will improve bone density over 3-5 years without risks, but if you didn't do any meds for 7 years it seems like natural post-menopausal bone loss would recur. Curious what others have to say!
@gravity3 I'm one of those who has serious concerns about Prolia. Also I am not at all sure that Prolia being substituted for Fosamax makes sense. The general problem with long term Fosamax (longer than 3-5 years) is that bone remodeling is suppressed too much for too long a time period. Bones can become fragile despite keeping their density. Is it proven that switching to Prolia a more powerful suppressor of bone remodeling solves the problem of overlong suppression? I believe I've heard some discussion of whether alternating anabolics with bisphosphonates might help deal with the problem of overlong suppression. The anabolics would cause remodeling to resume and potentially improve bone quality and architecture which would perhaps undo some of the harm of overlong suppression of bone turnover.
This is all theoretical, and wishful thinking on my part as that is the direction I'm going in. I will point out in my defense that much of what has happened over the past 30 years with osteoporosis medications at least in terms of a long term solution is not based on solid evidence. For example they gave folks Fosamax for years and years and years. They only knew it was ok for 2-3 years. Did no one think then that maybe suppressing bone turnover forever might cause some problems? Similar thing with Prolia did it occur to no one that very strongly suppressing might not cause some problems when you stopped the suppression?
Anyway I think it is reasonable to take Fosamax again for a short period, 1 year say, especially when you are alternating it with an anabolic med.
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2 ReactionsPersonally, I have serious concerns about Prolia. I am taking Alendronate after Evenity and it has worked well for me.
You say:“extending the time on treatment is what we all want if we have serious osteoporosis”
Question: If you get to DEXA -1 to -1.5 you’ll have to stop and try something to keep gains.
What’s the course of action in that case?
cc
I had Evenity for 1 year and have moved on to Prolia to help build more bone density. I will do 2-3 injections and then Reclast. I started BHRT almost a year ago at 71 years. My endocrinologist was against it and all new studies were pointing in the right direction. Look for video’s on YouTube by Dr. Doug Lucas. Hope that this helps with your decision going forward.
I skipped a month and then Prolia.