Evenity and epidural steriod injection

Hello @donnaj50,

I'd like to invite @ingridbergman, @bayhorse and @stress101 who discussed epidurals and steroid shots while on osteoporosis medications to share their experiences and questions they also had about the safety of doing so.

@donnaj50, What did your neurologist have to say about your concerns with getting an epidural while on Evenity? Were they worried about any possible contraindications between the two treatments? Does the level of pain outweigh the risk of getting an epidural?

Hi Justin,
The concern here is that steriods can contribute to bone loss. Evenity can cause necrosis of the jaw. So my understanding is that I should space out the two but I really don't know if that would even make a difference. I know I really need the steriod shot. The neurologist doesn't seem to know a lot about Evenity and the pain management doctor who does the epidural doesn't know anything about Evenity so I'm just trying to figure it out by myself. I was just hoping to find out if anyone knows if it would make any difference if I got the Evenity infusion a few days before I get the steriod shot or if I need to space them out.

@JustinMcClanahanyy
I was not on any bone meds at time of my procedure. I had been on Tymlos before stopping. The procedure did not help me at all but gave me very high anxiety afterwards.

@stress101 Good to know.

I was just trying to ask if it was ok to get the infusion one day and the steriod shot a few days later or should there be more time in between.

@donnaj50 When I asked my doctor if the steroid in the epidural was harmful for having osteoporosis. He said no. The epidural injections do not go into the bloodstream like steroid medications or steroid shots. Different procedures.
I would space your shots in my opinion. That way you know what helps or doesn’t.

@stress101
What Chat GPT. Said.
general, Evenity (romosozumab) and an epidural steroid injection don’t have a direct drug–drug interaction.

But timing still matters because:
• Evenity is an immune-active bone medication (monthly shot)
• An epidural steroid is a localized immunosuppressant

Many clinicians prefer not to stack procedures that affect healing/inflammation on the same day or back-to-back unless there’s a reason to.

Practical spacing (common approach)

If possible, it’s often reasonable to:
• Separate them by ~1–2 weeks
• Either: Evenity first → wait a week or two → epidural
• Or: Epidural first → wait a week or two → Evenity

Why?
• To avoid overlapping side effects (fatigue, aches)
• To reduce any theoretical infection/healing concerns
• To make it easier to tell what caused any new symptom

There’s no universal rule, so the safest plan is to have your spine specialist and the doctor prescribing Evenity coordinate the timing.

Bottom line

You don’t usually have to cancel one because of the other — but spacing them is often preferred when feasible.

You need to speak with your endocrinologist/ osteoporosis specialist about this question.

@stress101 That's what I'll do. Just to be safe I'll space them out.

@donnaj50 I just use Chat GPT at times when I need an AI explanation. Sometimes they can be overly cautious but at same time helpful in trying to understand. Not they not ever be wrong but I’ve seen my doctors use them too now looking up side effects on meds. I prefer to be cautious about meds in case I have a reaction. Had too many Drs say no side effects and yet because I am medicine sensitive I prove there are side effects. Everyone is different and you know your body better than anyone so always listen to yourself and feel safe with whatever you do.