Prolia vs. Evenity

Eventy can cause severe muscle and bone pain? Is that true? Hell, I spent yesterday in the ER with severe pain. I have been on Evenity for almost three months.

Wow sorry to hear all that I just got on evenity last week don’t known much about anything I just got diagnosed as well with severe osteoporosis I don’t even know much about that either I’m going to try to learn through you all many blessings to you

My two cents…

I had a myriad of issues including severe pain while on Tymlos, but no adverse reaction to either Evenity or Reclast. There is a general theme with Prolia that once started, it is very difficult to “unstart” and Reclast is used more as a maintenance med after Tymlos and Evenity. Unfortunately I don’t know much about Forteo, but I’ll need to begin my research as my doc says this year will likely be my last Reclast infusion due to the increased chance for a spontaneous femur fracture (I’ve had more than my share dating back to around 2011). It’s sometimes a pick-em; what worked for me just might not work for you.

It seems like all of these wonder drugs are more effective at building spinal bone than hip/femur bone so we should keep that in mind.

I wish you all the best as you begin your journey for better bone health. I’m still learning from all of our members on this board. Happy weekend, Cheers!

Hi @bayhorse - Sorry to hear the problems you are going through. While I cannot talk to how each drug might interfere with your current conditions, I can also give my two cents on treating your osteoporosis from a numbers perspective. Since your hip is at -3.4 after two years on Tymlos and you still have a ways to go to get to a lower risk of fracture, Evenity or Prolia do seem to be your best choices at this point. Reclast is not a good choice due to it's lower performance in the hip and it would hinder future drugs like Evenity.

If you are looking to get the best possible performance on bone building in the hip, I would recommend Evenity followed by a long run on Prolia. This would reduce your risk the quickest and the most over time. You would likely stay on Prolia for the rest of your life.

Another route would be just moving to immediately to Prolia and stay on it. This would reduce your exposure to just the one drug.

As for the side effects, both Evenity and Prolia are humanized monoclonal antibodies and are relatively safe. I started on Evenity and moved to Prolia, which I will likely be on for 10+ years. I have not noticed any side effects on either drug, but I am 60 years old without other conditions (for the most part).

I have seen studies on reduced doses on both drugs which just reduce the effectiveness and/or duration of the effectiveness. I'm not sure I would recommend reducing the dosage as these drugs are tricky on the timing of use, especially Prolia.

I put together a training based on all of my research that might be helpful for you. You can find them here youtube.com/@michaellavacot.

Finally, don't wait to transition to some other medication at the end of your Tymlos treatment. You can lose your gains over time without follow-on treatment.

Good luck!

@michaellavacot, thanks for your post. You're the only person who has responded to me so far with any information. I have appointments with a rheumatologist and an endocrinologist this coming week, and have a long list of questions for both. But the truth is, I am starting to feel better informed than either of them seem to be. I don't blame them: they have to deal with many other diseases than osteoporosis. So I've been relying on Dr. Doug Lucas's YouTubes for information, as he seems to be up on current research. I hoped they would help me make a decision, pointing me definitely to Evenity or Prolia. Unfortunately, my cardiac status (cardiomyopathy well managed by a pacemaker) stops me from gleaning any solid recommendation from in his videos.

From the standpoint of bone buildup, my inclination would be to start with a short course of Evenity, not the full 12 months. I've heard that any effects on the heart can somehow be lab determined within a matter of weeks, but I don't know if damage can also be done in that short of time.

I will look forward to watching your YouTube. Hope to learn something more. Meantime, thanks for your thoughts!

Hi, I have been on Evenity for 8 months and will be on Prolia when I finish 12 months on Evenity. The post above mine from Michael seems very helpful to me. If I were you, I would go to an expert in the field of osteoporosis, not a plumber. You should not have to decide for yourself, without solid medical advice from an expert, which treatment you should be on. I am 78, with Myasthenia Gravis, osteoarthritis and tinnitus for 15-20 years. Wishing you the best!

Hi @bayhorse. That's quite a big dilemma you're facing.
I was on Evenity, then Tymlos for one year and my rheumatologist wanted to put me on Prolia. I researched it and felt that I would prefer Reclast. I have autoimmune disorders that have seriously impacted my life, and from what I read, Prolia may be more likely than Reclast to wreak havoc on the immune system. My rheumatologist agreed, and I had my first Reclast infusion May 2025. This is just my personal story, and we all have them. The best thing I did was to switch doctors until I found one who really listened and respected me, took her time and is knowledgeable. The major thing I didn't know when I started treatment was that the sequence of medications is important and the long-term plan should be discussed from the get-go. I certainly don't have the comorbidities you have, but I noticed your comment that you haven't received much information and wanted to voice my support. If you want to take a deep dive, you might want to research this site by looking for posts about your conditions separately.
Wishing you the best of luck moving forward.

@hollygs, thank you so much for your thoughtful post. My autoimmune problems have likewise had an enormous impact on my life (loss of a career, etc.), and I have worked hard for the past 40 years to be somewhat "normal." With age has come spinal stenosis, which adds pain to the equation, so I am thankful at least that my heart is stable (pacemakers are pretty miraculous!). But I dread adding another drug to the mix and possibly making life even more of a challenge.

I have had great difficulty finding a physician who is really up to date on the osteoporosis drug research, which is nuts, because the Austin metro area is full of good doctors. But endos and rheumatologists seem to be prescribing by the old accepted formula: Tymlos followed by Prolia followed by Reclast. I am on the verge of paying a ton of money for Doug Lucas' Optimal Bone Health program, but even if I do that, I will have to have a local physician prescribe Evenity, Prolia, or Reclast, because they are given in clinic.

Another issue: Lucas' program for individuals starts off with a complex lab work up, and by the time his folks get results and make recommendations, I will already be done with Tymlos and likely losing bone. (I have been warned that that happens very quickly.) I also have been told that a cardiologist would need to be in the mix when it comes to recommendation because of the warning on Evenity. My cardiologist has pronounced Evenity worth the risk for me, but he felt an endo should make the final decision, so I worry still.

I have educated myself as to osteoclasts, osteoblasts, P1NP, CTX, relative risk reduction vs. absolute risk reduction, and treatment sequences until I'm crosseyed, and I keep coming back to the reality that I won't be able to foretell how I'll react to any drug. I did receive some responses from folks in the MayoConnect autoimmune illnesses group, and their experiences with osteoporosis meds have been mixed. But your idea of doing a deep dive per individual comorbidity makes a lot of sense, and I thank you for that!

Could you please let me know how long you were on Evenity and what your experience with it was like? I realize our experiences are all so individual, but the more info I gather, the calmer I tend to feel about the whole situation! 🙂

Thanks again for your good wishes and your support. I do appreciate!

@lesliestefani, thanks for your post. My cardiologist felt I wasn't at risk of heart attack or stroke on Evenity but in defining himself as just "the plumber," he meant he wasn't an osteoporosis expert and I should defer to my endo when it comes to choosing the drug. However, my endo wanted to know what my cardiologist thought about my risk level where Evenity was concerned. And there I stand in the middle trying to make the decision. It's as if I have all the data and no good advice. I wish for a true osteoporosis expert, but such an animal does not seem to exist in Austin, Tx. There are only endos and rheumies busy busy busy with patients with a myriad of other illnesses, and osteoporosis is just one sliver of their practices. So it is helpful for me to hear about the experiences others are having with these drugs, particularly from people with autoimmune issues.

Could you please tell me how you are doing on Evenity? Side effects, injection site issues, etc.? I would appreciate, if you would care to share.

Meantime, thanks again for your thoughts and support.

I was on Evenity for one year. I tolerated it very well - no issues whatsoever. DEXA and TBS showed good gains. My journey with osteoporosis meds is on this site under "Prescribed Tymlos after Evenity."
I was in the same boat - after finishing Tymlos I needed a new doctor and felt anxious about the timeline. Then I dialed back on the anxiety because I absolutely know that stress is terrible for my health and I don't want it in my life. I found a doctor who agreed to meet with me on a video conference the next day even though the usual wait for an appointment was 8 months. So I got lucky. Very lucky. I finished Tymlos 3/15/25 and my Reclast infusion was 5/12/25. My doctor put me on a drug holiday because I had been experiencing extreme fatigue and joint pain, and she thought it might be from the Tymlos and wanted my system to calm down. She was right as the fatigue and joint pain were gone in a month and haven't returned.
You're absolutely right that you can't foretell how you'll react to any drug. You've obviously educated yourself thoroughly. I will say that when I relaxed about the whole thing, I found it easier to tune into my intuition about what I should do. What I see from what you've mentioned is that your cardiac condition is stable and you seem to be more concerned about your autoimmune disorder.
Do let us know how you get on and what you discover.
Best wishes to you moving forward.