Update Evenity followed by 2 years of alendronate

@hikernurse
I finish Evenity in 4 months and my endocrinologist is set on prolia too...I just hate doing it!!! I wish there was something else.

@grammy9
I wish there was also. I will be researching. The alendronate was good for me for the first year after evenity. I continued to gain both in hip and spine. My spine was -1.6 and I was counting on a continued gain after the next 12 months but unfortunately I lost and back to 2.6 spine and hip back to -3.0. My initial was -3.3. So I’m hopeful another round of Evenity and then not sure. My doc said prob not reclast since it is a bisphosponate and since it didn’t hold he didn’t think reclast was strong enough. I’m thinking maybe one dose of prolia followed by reclast. I do plan to talk it over with Dr McCormick.

Please let me know what you decide. Has there ever been anyone go on Forteo or Tymlos after Evenity?
I am scared of being on Prolia forever and I am 63. Also, the jaw issues really concern me. What don't you like about Prolia?

@mayblin
Unfortunately CTX was just 489. I have completed 6
months of a second course of Evenity and medicare is covering.
So now I wonder if I should even complete the Evenity. I won’t have another DEXA til Oct 2026.
I did have successful bunion surgery Nov 2025 and am
completely recovered and exercising hard. I’ve added Brick House Bones workouts 3 times a week.
I will converse or text with my doc and see what he thinks but I’m thinking to ask him for P1NP, maybe a repeat CTX (even though I did it correctly) possible vitamin D even though it was 51 Oct 2025. Parathyroid was checked and okay. I keep track of calcium and vitamin D daily and always get 1200 mg calcium and 1000 vitamin D and supplement only when I don’t. Maybe increased the vitamin D to 1500. Maybe try for more protein, I’m probably borderline
most days.
At a loss as to what’s next and welcome any ideas. Maybe time to consult with Keith McCormick.
ChatGPT is telling me to finish Evenity and then quickly transition to Prolia/Reclast. They seem to favor Prolia as stronger. I’m so afraid of Prolia but if I could take one Prolia and then Reclast and watch CTXs……I don’t know it’s making me crazy but I haven’t fractured either so trying to stay positive. Any help from any of you brilliant gals and guys much appreciated!!! Cindy

@hikernurse, it's so great to hear that you recovered very well from the bunion surgery and that you are on your second round of Evenity with insurance coverage! I wanted to share a few thoughts based on I've read.

Your bone marker results might be a bit complicated to read because several factors are at play:
*prior fosamax treatment: reduces bone turnover overall and can dampen or delay the initial response;
*evenity: dual action - increasing formation while decreasing resorption;
*bunion surgery: could increase turnover markers especially in the first few months post surgery

Did you happen to have your CTX and P1NP tested right before you started this second round, and/or during the first 3 months? For most people, the biggest response in bone markers happens very early during evenity treatment. Despite this fact, your thinking of testing both P1NP and CTX soon is a good idea, so you know where the balance stands.

I found a really relevant 2024 Swiss study that looked at people in your shoes - those who transitioned to Evenity after prior treatment - and how their bmd and bone markers were affected: https://pmc.ncbi.nlm.nih.gov/articles/PMC11364696/

If i were you, id try to complete the full course, or at least 9–10 monthly injections, as clinical studies clearly show BMD continues to improve after 6 months, even if the gains are at a smaller magnitude.

Thanks for sharing, hope your journey a great success!

Edit to add, a blood level of ~50ng/ml vitD seems to be a sweet spot from what ive read...
There was a clinical study evaluating the use of prolia (1-2yrs) after completing evenity, which showed additional increase in bmd, then followed by reclast. You can also find some members' experiences on this forum with this sequence (evenity -> prolia 1-2yrs -> reclast).

@hikernurse That is very interesting. So you’re saying that after Evenity, alendronate didn’t help to maintain or continue the results after the first year, is that right? Are you getting bone scans yearly? I want to get yearly. I’ve been on Prolia (no problems) and scan after 2 years showed modest improvement in hips but not spine. I am considering Evenity but what to do following that is a plan to be made at the same time.

@grammy9 the jaw and femur issues apply to Prolia and also alendronates. I’m reading a lot of aversion to Prolia on this site but not alendronates. ??

@cphip I did aldronate for 9 years with no issues but I know it is mentioned alot.

@cphip Also have heard its bad with Prolia!!! Its all very scary. I talked to my dentist and he said he has several on Aldronate and Prolia and nobody has had issues. But....I am still nervous but just going to try the best thing I can.

@cphip Actually alendronate did well the first year. I added to the evenity gains but it was after the second full year of alendronate that I lost about 1/2 gains from the first year of evenity and 1 st year of alendronate. Doc thought since I did so well on evenity the first time to add a second year and then lock in gains with Prolia/Reclast. Yes Prolia worries me regarding jaw and atypical femur fx but if I could just take 1-2 doses and then transition to Reclast and of course always always always have an annual DEXA! I’m so glad I did after the first yr of alendronate and then the second year I again insisted on a DEXA and that is where I discovered alendronate was not strong enough. Prior to my first round of evenity I was treatment naive. The current round of evenity maybe somewhat affected by the alendronate prior 2 years