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Switching from alendronate to something else
My primary care is referring me to an endocrinologist. I’ve been on alendronate for 5 years and it’s time to change. My lumbar spine T score is -2.6. My hip is -2.1. I’m on Medicare with a supplement and need to select a part D plan that will cover whatever drug the endocrinologist recommends. Hopefully I know before December 7th open enrollment deadline. What do you think my medication options are? I’m 67, taking calcium plus vitamin D and lift weights 3x’s/week. No fractures but sore lower back and left hip.
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You are clearly in Osteoporosis territory based on the guidelines definition. What were your numbers before you began 5 years ago?
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1 ReactionMy lumbar spine T score was -3.0 in 2020. It went to -2.4 in 2022 after two years of alendronate.
But last scan in 2024 has me back to -2.6.
You might consider a drug holiday if you have not fractured. Alendronate has a half-life in your bones of 10 years so the alendronate you've taken will continue to be released and suppress bone remodeling once your osteoclasts become active again.
I also took alendronate for over five years and was looking forward to taking at least a year off all meds but I fractured just after the five year mark. I was switched to anabolic therapy because of the fracture.
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1 Reaction@oopsiedaisy What anabolic did you switch to? I am 66 years old and in March last year (2024) I finished 5 years of Fosamax. Before I started Fosamax, my hip was -2.5 and spine was -2.2. My DEXA in June this year showed my hip is back at -2.5 and my spine is -2.7. My rheumatologist first recommended Prolia, but I have moderate to advanced scoliosis and was terrified of possible fractures if I had to stop Prolia for some reason. Then she mentioned Reclast but I questioned whether bisphosphonates make future anabolics less effective, to which she said yes, they blunt their effect. She felt Forteo and Tymlos would not be effective for me as my intact parathyroid hormone level is 53. So we decided on Evenity, even though it scares me with increased heart attack and stroke risk. I don't have any heart issues and a recent CT heart calcium score was 0, but I do have 218 total cholesterol with 149 LDL. And I have always been a worrier with anxiety off and on, but lately the fear of these medicines has caused me more anxiety to the point of chest pains. I have since started on Lexapro. My rheumatologist felt that as long as I did not have a heart attack, stroke, or clots within the past 6 to 12 months, Evenity was an option for me. I will get my first dose in December so fingers crossed!
@chiefsmom I don’t have an appointment with a rheumatologist, but I will see an orthopedic doctor in December (for left hip and low back pain) and then an endocrinologist the week after that. I’d like an orthopedic doctors opinion on all of this. My mom had a hip replacement in her early 70’s, and I’m expecting I will need one. I’ve researched Medicare prescription plans and none of them cover Prolia or Evenity. I would have to find a doctor that orders the med and administers the shot in their office. My primary care said usually patients get the prescription at a pharmacy and bring it to the office. These meds cost $2100/year through part D. Can’t commit to that. I might wait until my next DEXA scan, eat healthy, exercise and use OTC supplements. If my numbers are the same next fall, maybe I can wait this out some more. These meds might be nice if you can afford them.
@chiefsmom both my daughter-in-law (an endo) and my own endocrinologist said evenity is safe and the heart problems aren’t a troubling warning. Their patients do well on it and they don’t hear complaints. I would’ve chosen it but my insurance was not going to pay much.
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2 Reactions@chiefsmom I was started on Tymlos and took it for four months before my insurance cancelled my authorization. I moved to generic Forteo but stopped after 2.5 months due to side effects.
At that point, I switched to an endocrinologist and started on Evenity. I have had seven shots so far. I have tolerable side effects from the Evenity (joint pain for the first two weeks after an injection).
I do not have any history of heart issues so I was cleared to take it from that perspective.
Did you ever have your doctor appeal your cancellation with a letter of “urgent” “medical necessity” including your diagnosis tscores etc. ?
Sometimes even if the drug is not on your insurance formulary and you are on Medicare you can still get covered. That’s what just happened to me. I had to bring the necessary documents to the doctor and say I want this. More importantly the doctor had to take the time and effort to insist. Got approved…in two hours! After taking nearly 3 weeks.
@morash25 You may want to check if your endocrinologist administers Evenity injections. My Medicare part B along with Medigap plan G fully covers Evenity when given through doctor's office. In my case, the doctor's office is in a medical complex that has an infusion center where they give Reclast infusions and Prolia and Evenity injections. Depending what your T scores are, you may not want to wait too long to get on medication as my doctor said that there is nothing I can really do at this point to increase my bone density enough as it keeps decreasing.
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2 ReactionsIt seems more and more are trying evenity with good results because it’s the only drug (I’m not sure) that affects osteoclasts and osteoblasts. You only take it one year once per month …that’s an easier for some. It does have cardiovascular risks.