Need Advise - What drug to Follow Up Evenity

Insurance plays too big a role in our treatment decisions. I'm fortunate that my insurance approved Evenity. At this point, I'm four sets of injections in, and looking at follow-up options. Next year, if available, I'm going to continue with the same commercial insurance plan. As we all know, the drugs available on each plan can change. In an attempt to be prepared, I'll have a Plan B and even a Plan C, while desperately hoping that Plan A works out.
As an aside---For those who are on or have had Forteo or Tymlos, did you encounter any issues with coverage to complete the full 18 month to 2 year treatment? I'm sure I've seen stories of the patient contribution ($$$) changing. Has that happened to you? Has anyone been denied coverage to complete the treatment?

I finally got the DXA results:
Right hip -2.2
Left hip -1.5
Lumbar spine -1.9

Impression: Severe osteopenia of the right hip, as well as moderate osteopenia of the left hip and lumbar spine.

Old DXA
Right hip -3.1
Left hip -3.0
Lumbar spine -2.5

The rheumatologist ordered Prolia. After my appointment, I had a few follow-up questions, because I was having second thoughts about taking Prolia. I asked the doctor’s assistant to relay questions and add CTX and P1NP to the blood text order. The assistant never got back to me. He doesn’t return calls. I’m frustrated. I would love your opinion.

I’ve never taken Fosamax. My orthopedic surgeon advised against it, so I went straight to Evenity.

Then I was referred to a Rheumatologist, who is very nice, but she doesn’t use tests (bone markers) recommended by the experts I follow on Social Media. She recommended Prolia and ordered it. I can start anytime after I get a blood test for Vitamin D and something else. I don’t remember.

You recommended on your video getting a CTX text. I requested that the doctor include that in the order. The assistant had never heard of CTX. I’m hoping it’s an option. Is there another text you recommend?

I’ve been worried about the delayed length of time after ending Evenity and starting Prolia or another drug. My rheumatologist said it wasn’t a problem, but I don’t fully trust her opinion. Starting immediately makes more sense. Good for you!

I finally got the DXA results:
Right hip -2.2
Left hip -1.5
Lumbar spine -1.9

Impression: Severe osteopenia of the right hip, as well as moderate osteopenia of the left hip and lumbar spine.

Old DXA
Right hip -3.1
Left hip -3.0
Lumbar spine -2.5

The rheumatologist ordered Prolia. After my appointment, I had a few follow-up questions, because I was having second thoughts about taking Prolia. I asked the doctor’s assistant to relay questions and add CTX and P1NP to the blood text order. The assistant never got back to me. He doesn’t return calls. I’m frustrated. I would love your opinion.

I finally got the DXA results:
Right hip -2.2
Left hip -1.5
Lumbar spine -1.9

Impression: Severe osteopenia of the right hip, as well as moderate osteopenia of the left hip and lumbar spine.

Old DXA
Right hip -3.1
Left hip -3.0
Lumbar spine -2.5

The rheumatologist ordered Prolia. After my appointment, I had a few follow-up questions, because I was having second thoughts about taking Prolia. I asked the doctor’s assistant to relay questions and add CTX and P1NP to the blood text order. The assistant never got back to me. He doesn’t return calls. I’m frustrated. I would love your opinion.

Hello…I was denied Tymlos when my doc first recommended it. Insurance wanted me to begin a regimen of Fosamax but because of my high loss -4.7 my doc appealed the decision and it was overturned. I finish 2 years in July.

Hi @prehorselover - Sorry for the delay.

It looks like you had really good results on Evenity, especially in the hip area. Based on the main Evenity trial that was followed by alendronate, I would start alendronate (Fosamax) ASAP. Get another DXA scan in two years and maybe you can take a break from drugs for a couple of years.

I would not transition to Prolia as you really don't need it in my opinion.

You're looking good! Mike

Thank you so much!

My goal is to increase my bone density enough that if I fell off a horse I wouldn’t fracture. I want to start riding my young horse in 18 months.

Is that possible with HRT, Fosamax, and jumping rope several times a week?

Hi @prehorselover - It's pretty difficult to put a probability of a potential break when a horse falls on you. I assume it's pretty high regardless of your T-scores. 🙂

If I were you, I would try the alendronate + HRT for 18 months and get another DXA scan to see where you're at. I'm not sure what target you should be shooting for specifically, but if you feel it's still to low, then you could do another round of Evenity. That should really push you over the top.