Evenity and Neurogenic Claudication: No Contraindication
Evenity (romosozumab) is not contraindicated in patients with neurogenic claudication. Neurogenic claudication is a neurological condition caused by spinal stenosis compressing nerve roots, not a vascular or cardiovascular condition that would interact with Evenity's mechanism of action or safety profile.
Key Distinction: Neurogenic vs. Vascular Claudication
- Neurogenic claudication results from mechanical compression of neural elements in the lumbar spine, most commonly due to degenerative changes, facet joint hypertrophy, and spinal stenosis 1
- Patients experience pain, numbness, or weakness that worsens with lumbar extension (standing, walking) and improves with lumbar flexion (sitting, bending forward) 1
- This is fundamentally different from vascular claudication, which is caused by arterial insufficiency and peripheral arterial disease 2
- Nonarterial etiologies, including neurogenic disease from spinal stenosis, represent up to 45% of patients evaluated for claudication symptoms 2
Why This Matters for Evenity Use
- Evenity's contraindications are cardiovascular in nature (myocardial infarction or stroke within the preceding year), not neurological
- Neurogenic claudication involves no arterial insufficiency or vascular pathology that would be affected by bone-building medications 1
- The pathophysiology is purely mechanical compression of nerve roots, with symptoms relieved by positional changes that reduce spinal canal pressure 1
Clinical Approach
- Proceed with Evenity if indicated for osteoporosis management in patients with neurogenic claudication, as there is no mechanistic interaction
- Focus neurogenic claudication management separately on multimodal conservative therapy including patient education, home exercise programs, and manual therapy 3, 4
- Do not confuse neurogenic claudication with vascular claudication when assessing cardiovascular risk factors for Evenity use 2
Common Pitfall to Avoid
- The word "claudication" may trigger unnecessary concern about vascular disease, but neurogenic claudication is a completely separate entity with different pathophysiology, diagnostic criteria, and treatment approaches 1
- Always distinguish between these conditions through history (positional relief with sitting vs. standing still) and appropriate vascular testing if uncertainty exists 2