Evenity Results and Next Steps

newenglandtransplant, these are truly fantastic gains - congratulations! You must feel so encouraged seeing such great progress. I'm very happy for you.

Out of curiosity, did your dxa also include femoral neck results or TBS?

Did you start HRT at the same time as Evenity? If you happened to monitored bone markers during therapy, I'd be really interested to see how they changed, only if you feel comfortable sharing, of course.

It's great that you've already got a long term plan. I've heard of people doing a second round of Evenity, so it's nice to know that's an option if ever needed.

Has your endo mentioned whether HRT alone should be enough to maintain your gains going forward, especially if estrogen deficiency is the main cause of your bone loss?

Thanks so much for sharing your experience!

Wonderful results. I also had great results with Evenity. I began bhrt just about the time I was finishing evenity. Currently on estradiol/testosterone pellet, progesterone and vaginal estradiol cream. My main goal was not help with my bones although I felt that it could help. What I don't have unfortunately is an endocrinologist who does ctx, monitoring. So, I am flying blind a bit.

That is good, I finish evenly in January I hope for the same.

Could someone let me know what CTX means? I've been treated for osteoporosis (Evista then Reclast) for decades and have never heard of this...

@tillymack, CTX (C-terminal telopeptide) is a bone turnover marker that reflects how much bone is being broken down (resorbed), so it indirectly measures how active osteoclasts are.

When you are on antiresorptives like Evista or Reclast, your CTX levels usually goes down. Because Reclast is a stronger antiresorptive than Evista, the drop in CTX is typically much greater with Reclast.

Measuring bone turnover markers isn't standard practice everywhere yet, but some endos do them to help guide treatment.

Thank you, @mayblin Yes, I’m feeling encouraged, which is a welcome feeling. And I’m happy to share anything I can.

First, femoral neck:

Left Femoral Neck: from -2.1 to -1.7, BMD +7%
Right Femoral Neck: from -1.8 to -1.5, BMD +6%

I started MHT the day after my first Evenity injections. While osteoporosis wasn’t the only driver for this, it was a factor.

My bone marker results were:

August 2024: CTX = 526, P1NP = 62
January 2025: CTX = 310, Bone Specific Alkaline Phophatase = 28
September 2025: CTX TBD prior to Reclast infusion in October

The switch from P1NP to BAP was due to seeing different doctors.

Over the last couple of weeks, I met with both my local doc and my Mayo doc. I opted to see both as I wanted to be absolutely sure about next steps. They each recommended the same - an initial infusion of reclast with additional infusions when indicated by CTX. And neither of them thought estradiol alone would be strong enough to maintain the Evenity gains. I asked my Mayo doc if a larger dose may be enough, and he did not recommend this. Disappointing for sure, but not too surprising.

The TBS is where things get a little interesting. I actually had two dexas in August - one at Mayo and one at the bone clinic near me. One of them will be out of pocket. I chose this because I wanted to be able to compare bone density pre and post Evenity. This meant a scan at Mayo on the same Lunar machine as last year. And I had a scan locally on the Yale clinic’s Horizon as my future scans may be local, and having a scan now will make for simpler monitoring of future BMD change. My T scores were pretty similar between the two machines, but the TBS was different. I haven’t had a chance to look too deeply at this yet.

TBS August 2024 to August 2025, Lunar: from 1.232 to 1.241, +1%
TBS August 2025, Horizon: 1.364

For now, I’ll share a paper from late last year on Evenity and TBS. Some interesting discussion, and the reference papers are also interesting.
https://pmc.ncbi.nlm.nih.gov/articles/PMC11789382/

may i ask what kind of dr is monitoring your drugs now? i could be wrong but i thought there is a particular type of drug needed to maintain the progress

My endocrinologist monitors my osteoporosis medications. I have been on prolia for close to a year. Not ready yet to stay on it for more than 2 shots at 77. I am going to discuss whether it is feasible to transition to a light dose of reclast, then perhaps tymlos or evenity again. Should be an interesting discussion because he does not do ctx monitoring and I want it. We always have a lively discussion.

Interesting paper. Thanks for sharing.

Thank you so much @newenglandtransplant, for sharing all the details about your treatment! I have a few thoughts I wanted to share, but please take them with a grain of salt.

Your bmd response has been truly outstanding. The gains you’ve seen are well above the average reported in clinical trials, and what’s most impressive is that you had significant bmd increases at all skeletal sites. The femoral neck in particular is notoriously the hardest site to improve, so seeing that degree of improvement is especially encouraging.

TBS readings on the Lunar scans looked fairly stable from 2024 to 2025, whereas the Hologic machine gave a value nearly 10% higher. That difference is larger than what’s typically expected between different platforms. In terms of treatment effects, TBS improvements are usually more evident with teriparatide or abaloparatide and less so with romosozumab. This likely relates to mechanism of action: romosozumab’s modeling-based bone formation primarily increases trabecular thickness rather than trabecular number, which may explain its more modest effect on TBS:
https://pmc.ncbi.nlm.nih.gov/articles/PMC7027577/
Your CTX changes look consistent with expectations. BSAP reflects later stages of bone formation and mineralization, and i haven’t read much about its usual timeline or magnitude of change. To me HRT didnt shown a major effect on your markers (yet), which may simply reflect the delayed onset of estrogen’s full impact on bone turnover.

It’s fantastic that you and your doctor are planning to use CTX to help time Reclast dosing. Do you have a specific CTX “target” in mind as the threshold for redosing? CTX can stay pretty low in 100s with a small dose of transdermal estradiol 0.025 (as several members here have experienced including me) - if your HRT keeps yours low enough, it’ll be interesting to see whether your doctor still feels another Reclast infusion will be necessary down the road.

One other thought: estrogen suppresses bone remodeling, which could interfere with the remodeling-based anabolic effect of PTH analogs. Its interaction with romosozumab (a modeling-based anabolic) is less clear, and it will be interesting to see how research evolves in this area. For now, you’re in a great position with the remarkable gains you’ve achieved. Please keep everyone updated with your progress and future decision. Congratulations again!