We now have a third anabolic medication to build new bone. Evenity is really different from the other anabolics, Forteo (teriparatide) and Tymlos (abaloparatide). Forteo and Tymlos are daily shots based on the human hormones PTH and PTHrP. Evenity is an antibody to the human hormone sclerostin.
Sclerostin controls bone formation by telling osteoblasts to stop making new bone, and telling osteoclasts to gobble up old bone. This results in stable bone turnover remodeling (until menopause decreases control over the osteoclasts and they go wild). Evenity suppresses sclerostin.
Evenity markedly increases new bone matrix formation within the first month.However, the ability of Evenity to increase new bone formation diminishes month by month until it is mostly gone by one year. Therefore, it has been approved for use for only one year at a time. Like Forteo and Tymlos, Evenity must be followed by an antiresorptive to preserve the increase in bone.
Evenity also suppresses bone resorption by the second month. This is a less dramatic action, but it continues at the same level to the end of the year. The net result is a significant increase in bone matrix by the end of the year, in the same general order of magnitude as Forteo and Tymlos.
Evenity is a monthly shot into the subcutaneous fat on the back of both arms by a healthcare professional.
There is a possibility that Evenity may increase cardiac events in persons who have had a recent stroke or heart attack. This was found in only one of the 3 clinical trials of Evenity.
Preauthorization is required for insurance to cover Evenity. Most insurances will probably cover it within the first 3-12 months. More next time.
Jay Ginther, MD