When can I start Prolia (denosumab) after completing 12 months of Evenity (romosozumab) for osteoporosis?

When to Start Prolia After Completing Evenity for Osteoporosis

You should start Prolia (denosumab) immediately after completing your 12-month course of Evenity (romosozumab), with no gap between treatments. 1

Rationale for Immediate Transition

The FDA label for Evenity (romosozumab) clearly states that the anabolic effect of the medication wanes after 12 monthly doses of therapy, and therefore:

• The duration of Evenity use should be limited to 12 monthly doses
• If osteoporosis therapy remains warranted, continued therapy with an anti-resorptive agent should be considered immediately following Evenity 1

This sequential approach is critical because:

1. The bone-building effects gained during Evenity treatment need to be maintained
2. Without follow-on therapy, BMD returns to approximately baseline levels within 12 months 1
3. Denosumab (Prolia) is an appropriate anti-resorptive agent to follow Evenity

Evidence Supporting Sequential Therapy

The 2022 American College of Rheumatology guidelines for osteoporosis strongly support sequential therapy after romosozumab:

• If romosozumab (ROM) is used, it must be followed with a course of bisphosphonate or denosumab 2
• Sequential therapy is essential to prevent rebound bone loss and vertebral fractures after discontinuation of romosozumab 2

Clinical trials have demonstrated that:

• Romosozumab followed by an anti-resorptive agent (like denosumab) provides continued BMD increases and fracture reduction 3
• In the FRAME trial, patients who received romosozumab for 12 months followed by denosumab showed significant reduction in vertebral fractures (75% lower risk) compared to those who started with placebo 3

Timing Considerations

The FDA label for Evenity specifies:

• Evenity is administered once monthly for 12 months
• After 12 months, if osteoporosis therapy remains warranted, continued therapy with an anti-resorptive agent should be considered 1

There should be no gap between completing Evenity and starting Prolia to prevent any potential bone loss during a treatment gap.

Potential Pitfalls to Avoid

1. Avoiding treatment gaps: Failure to start Prolia immediately after completing Evenity may result in rapid bone loss and increased fracture risk 1

2. Duration of therapy: Evenity should not be used beyond 12 months as its anabolic effect wanes after this period 1

3. Monitoring needs: While transitioning to Prolia, continue calcium and vitamin D supplementation as recommended during your Evenity treatment 2, 1

4. Previous treatment considerations: If you had been on denosumab before starting Evenity, the effectiveness of the 12-month romosozumab treatment may have been affected by the duration of your previous treatment 4

By following these recommendations and starting Prolia immediately after completing your 12-month course of Evenity, you will maximize the bone-building benefits gained during Evenity treatment and maintain improved bone mineral density for better long-term outcomes.