What are the cardiac effects of Romosozumab (Evenity) injections and Abaloparatide (Tymlos)?

From the Guidelines

Evenity (romosozumab) should be avoided in patients with a history of myocardial infarction or stroke within the previous year due to its increased risk of major adverse cardiovascular events (MACE), and Tymlos (abaloparatide) may be a safer option for patients with significant cardiovascular disease. Both Evenity and Tymlos have potential cardiac effects that should be considered when prescribing these osteoporosis medications. Evenity carries a boxed warning for increased risk of MACE, including heart attack, stroke, and cardiovascular death, as noted in the 2023 guideline from the American College of Physicians 1. For patients with other cardiovascular risk factors, the benefits and risks should be carefully weighed before starting treatment. Evenity is typically administered as two consecutive subcutaneous injections of 105 mg each (210 mg total) once monthly for 12 months. Tymlos has been associated with orthostatic hypotension, which can occur within 4 hours of injection, but does not carry the same level of cardiovascular concern as Evenity, according to the comparison of interventions in the 2023 guideline 1. Tymlos is administered as a daily 80 mcg subcutaneous injection for up to 2 years. The different cardiovascular risk profiles of these medications should guide selection based on the patient's cardiac history and risk factors.

Some key points to consider when prescribing these medications include:

• The increased risk of MACE associated with Evenity, particularly in patients with a history of cardiovascular disease 1
• The potential for orthostatic hypotension with Tymlos, which can occur within 4 hours of injection 1
• The importance of weighing the benefits and risks of each medication in patients with cardiovascular risk factors
• The different mechanisms of action of Evenity and Tymlos, which may influence the choice of medication for individual patients.

Overall, the choice between Evenity and Tymlos should be based on a careful consideration of the patient's cardiac history and risk factors, as well as the potential benefits and risks of each medication.

From the FDA Drug Label

EVENITY can cause serious side effects, including: increased risk of having a heart attack, stroke, or death from a cardiovascular (heart or blood vessel) problem In the clinical trial of women with postmenopausal osteoporosis, the incidence of all-cause mortality was 0.4% in the TYMLOS group and 0. 6% in the placebo group. Tachycardia In women with postmenopausal osteoporosis, adverse reactions of tachycardia, including sinus tachycardia, were reported in 2% of patients receiving TYMLOS and 1% of patients in the placebo group.

Both Evenity and Tymlos have potential cardiac effects.

• Evenity may increase the risk of heart attack, stroke, or death from a cardiovascular problem 2.
• Tymlos has been associated with tachycardia, including sinus tachycardia, and may cause an increase in heart rate 3. It is essential to carefully evaluate the benefits and risks of these medications, especially in patients with a history of heart or blood vessel problems.

From the Research

Cardiac Effects of Evenity Injections and Tymlos

• Evenity (romosozumab) and Tymlos (abaloparatide) are used to treat osteoporosis, but their cardiac effects have been a concern.
• A study published in 2025 4 found that romosozumab was not associated with an increased risk of cardiovascular disease compared to bisphosphonates in Japanese patients with osteoporosis.
• However, another study from 2022 5 reported a higher risk of cardiovascular events in patients receiving romosozumab, and the drug carries a black box warning for patients with a history of myocardial infarction or stroke in the preceding year.
• A systematic review and meta-analysis from 2020 6 found that romosozumab therapy might increase the risk of major adverse cardiovascular events (MACE) in elderly men and postmenopausal women with osteoporosis.
• A pharmacovigilance analysis from 2021 7 identified a potential signal for elevated MACE with romosozumab, particularly in Japan.
• Another review from 2021 8 discussed the clinical pharmacology, efficacy, and safety of romosozumab, and noted that serious cardiovascular and cerebrovascular events were numerically higher in clinical trials when compared with alendronate and placebo.

Comparison of Cardiac Effects

• The cardiac effects of Evenity injections (romosozumab) and Tymlos (abaloparatide) are not directly compared in the available studies.
• However, the studies suggest that romosozumab may have a higher risk of cardiovascular events, particularly in certain populations such as elderly men and postmenopausal women with osteoporosis.
• Clinicians should carefully consider the potential cardiac effects of these medications when prescribing them to patients with osteoporosis, especially those with a history of cardiovascular disease 5, 8.

Key Findings

• Romosozumab may increase the risk of major adverse cardiovascular events (MACE) in certain populations 6, 7.
• The cardiac effects of romosozumab are still being studied, and more research is needed to fully understand its safety profile 4, 5, 8.
• Clinicians should be aware of the potential cardiac effects of romosozumab and carefully monitor patients receiving this medication 5, 8.