Reclast affect on Evenity ?

255anny,
Evenity's effect may be blunted by prior use of Reclast, but it will increase bone density after Reclast. The deposition of bone with Evenity is almost all modeling which doesn't involve the osteoclasts that are efficiently blunted by Reclast. Evenity's mechanism of action is different than the bisphosphonates as it increases the number of osteoblasts.
You might advantage the measured effect of Evenity by delaying treatment, but the delay wouldn't advantage the total effect on your bones.
Some doctors say that one year of Reclast has the same effect at two years as two consecutive years of Reclast.
You'd have additional fracture risk prevention if you had the Evenity injections after the first year of Reclast.
If you were at high fracture risk, you might not want to wait that extra year.
Bone markers are always wise. I'd have them before, and at three months.

@gently my doctor does not think bone markers tell the whole story. I am not agreeing or disagreeing because I don't know his full rationale and am going to ask him again.

@255anny do you have a doctor you can trust? It seems as if, at this point, that would help you the most. This forum shares experiences and we all read, watch videos, look at studies but the bottom line is having a doctor you can trust. I think you should be able to ask this question of your endo and if not, maybe a second opinion?

Thank you - your explanation is what I was looking for :-).
I am very high fracture risk, so I would not want to wait for that additional year to start the Evenity.

My Dr is new to me but she is not new to Osteoporosis. My old Endo retired - he was very well respected in the US - lots of publications, very active with all bone research and conferences. He was very involved in writing the dosing guides for these drugs. He told me I would be in very good hands with the Dr taking over his practice. But they are 2 people, with different approaches. I will ask her about this.
Thank you for supporting me - this drug decision has been tough. I'm ready to put it away.

The issue of Evenity after Reclast is complex. Evenity raises P1NP for the first months or even weeks (see the chart on Ben Leder's video) and then is a relatively weak anti-resorptive (again according to the video). My doctor says they don't really know how it works! Inhibition of sclerostin, which is found throughout the body (according to what I read online and in "Great Bones") also has complex effects.

It is great that we share our stories and research but in the end, I think a good doctor is in touch with the latest info and protocols- if there are any! I hope you can trust your new endo. It is so hard when the docs we know retire, and many of them are retiring after the Wild West of Covid.

@windyshores, I completely agree with your doctors. Bone markers are just fragments.
But then dxa doesn't tell the whole story. And our doctors, wonderful as they are, aren't omniscient and so can't tell us the whole story.

This member is seeing her doctor tomorrow, planning to ask important questions. Can you think of any way to deepen her understanding and enhance her questioning.

@255anny Why are you having Reclast ahead of Evenity? Maybe I missed some conversation elsewhere? Evenity works better before anti-resorptives. It is more preventative of fractures if you are at high risk of fractures. For the individual it's best for anabolics first and anti-resorptives after. For corporate and insurance interests it goes the other way it seems. The status quo at this time is xxx backwards imo. Yes, Evenity should still work after Reclast but I suggest the opposite strategy unless there is some overriding concern I don't see in this thread?

I am finishing my first course of Evenity this month. (prior to that I was on Forteo, 2ys)
My Dr was suggesting I now transition to 1 yr of Prolia, then return to Evenity. I'm not comfortable with that medication sequence.
So my thoughts now are transition to Reclast for 1 yr. then return to Evenity, if possible.

@255anny Oh, I see the situation now. Thanks. I am just finishing my first round of Evenity and trying to decide what next. My doc also suggests Prolia and I don't want to do that. It's certainly reasonable to do Reclast and then come back to Evenity. I think the problem for those finishing Evenity and wanting to come back to it again after a year is what can we do to keep our gains from Evenity for a year but not greatly lessen our ability to respond to Evenity round two.
Best of luck

Hi @255anny attached are graphs from a 2022 review paper by Dr. F Cosman regarding romosozumab (Evenity) and antiresorptive treatment sequencing. Although alendronate (Fosamax) was the bisphosphonate used in the studies, you can see prior treatment of alendronate, a bisphosphonate, does attenuate the effects of evenity to certain degree - as shown with the orange bars in the graphs on the left. I know we can’t simply extrapolate the results to reclast, however, this might give us some ideas and may provide a discussing point with the doctor.

Regarding bone turnover markers, it depends what the treatment(s) will entail. Reclast does not have bioavailability issues like fosamax, a standard dose of iv 5mg should get your osteoclasts suppressed hence a pretty low CTX. If in case your endo is going to do some treatment variations, then I think it’s worth to do them. For example, if you and your endo want to monitor how you are going to respond to the second round of evenity in the future (other than the dexa scan in the end), s/he might want to monitor bone markers along the way and watch trends. Also, in case your future round evenity won’t be approved by insurance and your endo wants to time next dose of Reclast, then you need to know your CTX level.

There could be times when we don't really know what next step will be, not testing bone markers means we miss info along the way. I didn’t have my baseline bone markers done and I will never have that info. But currently my endo is monitoring my bone markers on a regular basis in order to adjust my HRT dose accordingly if needed.
https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Click%20on%20image%20to%20zoom&p=PMC3&id=9106644_198_2021_6174_Fig2_HTML.jpg