How Evenity Works for Osteoporosis

Medically Reviewed by Christina Bookwalter, PharmD, BCPS, BCACP, MS MEd on August 08, 2024
9 min read

People with osteoporosis may take various medicines to help reduce their risk of breaking a bone. Many of these medicines work by slowing bone loss. There is also one medicine that works by helping the body build new bone. This medicine, Evenity, is injected into the body and may be an option for people who are at a very high risk of breaking a bone.  

Throughout our lives, our bodies are constantly forming new bone and breaking down old bone. As we get older, the body begins to break down more bone than it forms, which causes bone loss. 

Bone loss causes lower bone density and bone mass. If a person’s bone density drops further than would be expected for their age, they have a condition called osteopenia. A separate condition, osteoporosis, means that someone has very low bone density for their age and is at an increased risk for breaking a bone (fracture) or has already broken a bone. Some people who are diagnosed with osteoporosis have experienced a type of fracture called a fragility fracture, which means that they broke a bone during an accident that wouldn’t normally be expected to break a bone (such as falling from a standing position). 

Although there is no way to completely reverse osteoporosis, there are many lifestyle changes that can help to keep osteoporosis from getting worse. Diet is one important component of bone health. Getting enough calcium and vitamin D in the diet can help to slow down bone loss. Similarly, eating a well-rounded diet with fruits and vegetables will provide other important bone nutrients such as magnesium. Regular physical activity is another important component of bone health that helps to keep the bones stronger and denser. There are also certain lifestyle choices that can make bone health worse:

  • Smoking can weaken your bones
  • Drinking too much alcohol can make your bones weaker and also increase your risk of falling
  • Drinking large amounts of caffeine each day can make the bones weaker over time

Medicines also play an important role in keeping osteoporosis from getting worse. These medicines work on the body’s natural process of making new bone and breaking down old bone. Most of the available medicines, which can be taken by mouth or injected into the body, work by keeping the body from breaking down bone as quickly. Over time, this can slow bone loss and keep your bone density from getting much worse.

Evenity, which is injected into the body, works in a different way. The main ingredient in Evenity, romosozumab, blocks a substance in the body called sclerostin from working. By blocking sclerostin, Evenity helps the body to build more new bone. This helps to increase bone mass and bone density, which can help prevent a bone fracture.

Most people with osteoporosis will take medicines that help to slow down bone loss. If you are not able to tolerate these medicines, Evenity may be an option for you. Also, if you are at a very high risk of having a serious fracture, your health care provider may discuss Evenity with you. This is because Evenity may help to lower your risk of a bone fracture faster than other osteoporosis medicines. 

Evenity is a liquid that is injected under the skin by a health care provider in a health care setting. Each dose requires two injections, which are typically given in different parts of the body. Each injection can be given into the thigh, stomach, or outer area of the upper arm. 

The medicine is stored in the refrigerator. Before your injection, your health care provider will remove it from the refrigerator and allow it to warm to room temperature for 30 minutes. This will make the injection more comfortable. 

Evenity is given once every month for 12 months. While you are using Evenity, you will also be asked to take a calcium supplement and vitamin D supplement every day. This will help to make sure that your calcium levels do not drop too low during your treatment. 

After you have finished 1 year of treatment with this medicine, your health care provider will prescribe another medicine for your osteoporosis. 

Two studies were done to see if Evenity was safe and effective for reducing the risk of a serious bone fracture in people with osteoporosis. These studies took place in many parts of the world, including North America, Latin America, Europe, and Asia. All of the people in these studies were postmenopausal women who were 55 and older.

One of these studies compared Evenity with placebo. Here is some important information about this study:

  • To be in the study, each person had to have a bone density that was much lower than expected for their age. About 40% of the people in this study had already had a bone fracture.
  • The average age was 70, and most of the people (69%) in this study were under 75.
  • About 40% of the people in the study were Hispanic. The race of the other people in the study was not reported.
  • No one knew whether they were taking the medicine or the placebo. After 1 year in the study, everyone stopped the medicine/placebo and switched to another medicine called denosumab (Prolia) for another year. This medicine, which is injected into the body, works by slowing down bone loss.

The other study compared Evenity with a different medicine called alendronate (Fosamax). Alendronate, which is taken by mouth, works by slowing down bone loss. Here is some important information about this study:

  • To be in this study, each person had to have a bone density that was much lower than expected for their age and already experienced at least one bone fracture.
  • The average age was 75; about half of the people were under 75 and about half were over 75.
  • A little less than one-third (31%) of the people in the study were Hispanic. The race of the other people in the study was not reported.
  • No one knew whether they were receiving Evenity or alendronate. After 1 year in the study, everyone switched to alendronate. They took this medicine for another year.

During both studies, everyone took a calcium and vitamin D supplement every day. These studies measured efficacy by counting the number of new fractures that happened during the study. 

Number of fractures. After 1 year in the study that compared Evenity with placebo, the people using Evenity had fewer fractures in the spine (vertebral fractures) than the people using placebo. At this point, everyone changed to a different medicine called denosumab. After 1 year of using denosumab, the people who originally used Evenity still had fewer fractures in the spine than the people who originally used placebo. 

In the study that compared Evenity to alendronate, everyone used one of these medicines for 1 year. Then they all took alendronate for another year. After 2 years in the study, the people who originally used Evenity had fewer fractures than the people who used alendronate for the full 2 years. This included fractures in the spine as well as fractures in other major bones in the body, such as the hip, leg, or arm.

Although osteoporosis is most common in women, it affects men as well. One clinical study was done to evaluate whether Evenity was safe and effective in men who are 55-90 years old. The average age in the study was 72. Everyone had low bone density for their age and had already experienced a fragility fracture. Most (74%) were White, 11% were Asian, and 15% did not have a specific race reported.

Evenity was compared with placebo, and no one knew if they were receiving the medicine or the placebo. Everyone took a calcium and vitamin D supplement every day. The study measured efficacy by looking at the change in bone density in the lower spine from before the study started until after 1 year in the study.

The people who used Evenity had an average 12% increase in the bone density of the lower spine after 1 year, compared with an average 1% increase in the people who used placebo. This means that the people who received Evenity had a larger increase in their bone density than the people who received placebo. 

Unlike the studies in women, this study did not count the number of fractures. Even though a higher bone density is expected to lower a person’s risk of fracture, it isn’t yet clear whether Evenity reduces a male adult’s risk of having a fracture in the spine or another major bone in the body.

Even if Evenity is working, you may not be able to tell. Over time, Evenity should make it less likely for you to have a serious bone fracture. Your risk of a fracture may go down within the first few months of using the medicine. 

Since you will not be able to tell whether Evenity is working for you, it is important not to stop using the medicine without talking to your health care provider first. After you have finished using Evenity for 1 year, your health care provider may prescribe another osteoporosis medicine. This medicine will help to maintain the benefits from Evenity over time, so it is important that you take it as directed. 

Some people may have a serious allergic reaction (anaphylaxis) to Evenity. Each dose of this medicine will be given by a health care professional in a health care setting, where you will be monitored for an allergic reaction. If anything happens, trained professionals will be there to manage any side effects.

One possible side effect of Evenity is a skin reaction at the injection site, which may involve redness and pain. One way to reduce these reactions is to inject the drug into a different part of the body each time, which is called rotating the injection site. Make sure to let your health care provider know where the drug was injected the previous time and whether a certain injection site has been more painful for you. 

In rare cases, Evenity can cause severe jawbone problems called osteonecrosis of the jaw. These jawbone problems are caused by reduced blood flow and are more likely to happen in people who are undergoing certain dental procedures (such as a tooth extraction or dental implants), have poor oral health, or have certain medical conditions. To help reduce the risk of these issues, it is important to practice good mouth care. You may also be told to see a dentist before starting Evenity. 

These are not all of the possible side effects. Talk with your health care provider if you are having symptoms that bother you. If you experience anything that you think may be caused by Evenity, you can also report side effects to the FDA at 800-FDA-1088.

There are no known interactions between Evenity and other medicines. But it is still important for your health care provider to be aware of all the prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, or other supplements you take or have recently taken. 

Evenity is a type of medicine called a “specialty” medicine. This means that it may require prior authorization from your insurance company. Each dose of Evenity will be administered by a health care provider in a health care setting. Depending on your insurance, the medicine will either be shipped to you or to your health care provider. If it is shipped to you, you will need to bring it with you to your appointment. 

There is a savings coupon available from the manufacturer that may allow you to pay as little as $25 for your prescription. Whether you are eligible depends on whether you have prescription insurance and the type of insurance. You can find out more at www.evenity.com/paying-for-evenity