Prolia then Evenity?

I would start with Evenity (or another anabolic like Tymlos or Forteo) if that's an option as it builds up bone density to improve your numbers, before you go on something to "hold steady". I believe Evenity can be taken for one year. Be cautious starting Prolia so young until they find a way to successfully go off Prolia and avoid its rebound effect when you stop taking it (they are doing a lot of studies on it currently so hopefully they'll have some more definitive options in the near future). I didn't qualify for Evenity (my insurance wouldn't approve it), so I started with Tymlos (an anabolic bone building medication). My spinal bone density increased almost 20% on Tymlos. I then had an annual Reclast infusion to "lock in the gains"). I will have two more annual Reclast infusions, then go off drugs for a few years since it stays in your system for some time. I will have bone marker testing done while on the "drug holiday" to determine when it's time for the next step. Evenity may be in my future someday. I was 51 when diagnosed, now 54 so I have a long road of osteoporosis drugs in my future - the order they are taken in matters. My mom is on Prolia, she's in her 80's however so at this point they are planning to keep her on it for the rest of her life (unless they can find a definitive way to avoid the rebound effect). It can be great for protecting from breaks with a twice yearly injection, however, if too long on it, it eventually can cause issues (as all the meds can) and coming off of it can be a challenge. Good luck!

Both Evenity and Prolia are manufactured by Amgen. Their website provides a significant amount of information (which favors their products). https://www.evenityhcp.com/why-evenity/choose-anabolics-first

Sound advice from @misst1970 though I don't know about potential issues regarding your preexisting conditions.

Thanks so much for your long reply, @misst1970 ! So grateful your sharing and expertise. It seems I cannot begin with an anabolic because of my recent invasive breast cancer and the aromatase inhibitor 5year period. My bone doctor feels that Prolia is best to combat the AI effects on my bone density. So — Prolia for just 3 years, and then move on to Evenity. I’m anxious about adding more medication to treat the effects of my current medication, but since I’m at high risk of vertebral fracture (don’t even want to know how debilitating that might be), it seems I have no choice.
Thank you, thank you!!

Thanks so much, Michael! I just watched some of your YouTube presentation on Prolia. My doctor is recommending short term use of Prolia (3 years), followed immediately by 2 years of Evenity (as soon as I come off the Aromatase Inhibitor that causes bone loss. While I mostly trust my doctor’s expertise, does this make sense to you..?
You are a great gift to this online group, bringing your engineering background to this subject! Thank you!! I’m a psychotherapist, if anyone would like my take on anything. 🙏🏻

My experience with Prolia was that it did not work. I have had a broken wrist and five thoracic fractures in the past two years while actively being on Prolia. I start Evenity in August. I have really good things about Evenity. I hope it works for me.

Hi @risagee - Outside of your prior / existing issues (which could complicate medication choices), it does not make sense for someone to use Prolia and then follow it with Evenity. If I were you, I would talk to your doctor to see if they have a sound reason for using Prolia first. If not, then you might need to educate them on the vast benefits of using Evenity first, then move to Prolia if needed. You would need to get a DXA scan done on month 11 on Evenity to determine the best follow-on treatment. Perhaps Fosamax would be sufficient but it depends on your T-Scores.

Thank you, Michael.
I think my doctor chose Prolia so that I can take it for the duration of my required aromatase inhibitor medication (3-1/2 more years). I think it’s recommended more frequently than Evenity, Tymlos etc. for post breast cancer patients who might be at risk for developing bone cancer. Once I’m done with it, she feels Evenity will help build up my crumbling spine. Does that make more sense to you?

After a quick ChatGPT session, it does not look like Evenity is contraindicated for aromatase inhibitors, but it also looks like Prolia is the go-to medication for it's safety profile. During the 2025 World Congress on Osteoporosis, Dr. Leder mentioned that if he was to transition a patient from Prolia to an osteoanabolic, that he would first use a bisphosphonate to get better results with the osteoanabolic. That said, depending on your situation, age, T-scores, he might consider keeping you on Prolia and just add Forteo for a few years as a booster. I talk about that in the Prolia presentation https://youtu.be/hnj1tFUAK3M?si=JspNYP-FhtMiiQUA&t=2820

Hi @risagee - After thinking about it last night, I think your doctor might be on the right track. If Prolia is the best treatment while on aromatase inhibitors for 3 1/2 years, using Evenity for one year to counteract the rebound, and maybe build a bit in the spine as well, then taking a second year of Evenity might be outstanding. I have seen a two year study for Evenity and there was still a substantial benefit. This might be the best course to take.

Good luck!