1. < Osteoporosis & Bone Health

Reclast affect on Evenity ?

Posted by 255anny @255anny, Sep 9 9:22pm

I see my Endo Dr. Wednesday. Hopefully I can resolve this drug issue and move on. I have one question. It has been brought up in our discussions, but I'm wondering if any of you can expand on it a bit further. If I have the 1 infusion of Reclast and the plan is to follow that with 1 yr. of Evenity, do you begin the Evenity 12 months after the Reclast infusion? I seem to remember some mentions that the Reclast is so strong it might blunt the Evenity. If this is so, then would the start of the Evenity be delayed further out than the 12 month mark from the Reclast infusion? Do you need bone markers to measure this?

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255anny | @255anny | Sep 10 10:11pm
In reply to @mayblin "Hi @255anny attached are graphs from a 2022 review paper by Dr. F Cosman regarding romosozumab..." + (show)
@mayblin

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

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Thank you. I'm hoping my visit with her answers some of my questions 🙂 But this will be a short appt, so we shall see.

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windyshores | @windyshores | Sep 11 5:12am
In reply to @255anny "Thank you. I'm hoping my visit with her answers some of my questions :-) But this..." + (show)
@255anny

Thank you. I'm hoping my visit with her answers some of my questions 🙂 But this will be a short appt, so we shall see.

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Here is an article on bone markers (and chornic kidney disease)
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5628199/
and an excerpt:
For these reasons, especially in CKD, it is important to realize that estimating bone turnover by measuring circulating biomarkers is full of pitfalls, that even a reliable estimate of turnover does not indicate changes in bone balance, and that fracture risk is also dependent on bone features that cannot be assessed by biomarkers, nor even by bone histomorphometry like architecture and bone strength

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