Evenity
Evenity (romosozumab or romosozumab-aqqg) is an injection used to treat osteoporosis (bone loss) in certain women after menopause. These women either have a high risk of fracture or can’t take other medications for bone loss. It's also used when these other medications haven’t worked well enough. Evenity (romosozumab) belongs to the drug class called sclerostin inhibitors. It works to help your bones grow and prevent bone breakdown at the same time. The injection is given once a month by a healthcare professional. Common side effects are joint pain and headache. There's also serious risks of heart attack and stroke. This medication is brand name only; there's no generic available yet.
What is Evenity (romosozumab)?
What is Evenity (romosozumab) used for?
- Treatment of osteoporosis in certain women after menopause
- With high risk of fracture
- Who can’t take other medications for bone loss
- Who tried other medications for bone loss that didn’t work
How Evenity (romosozumab) works
Evenity (romosozumab) is a sclerostin inhibitor. It blocks a protein in your body called sclerostin. Sclerostin normally stops bone growth and promotes bone decay.
By blocking sclerostin, Evenity (romosozumab) helps your bones grow and prevents bone loss at the same time.
Drug facts
More on Evenity (romosozumab) essentials
Side effects of Evenity (romosozumab)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Joint pain (up to 13%)
- Headache (up to 7%)
Less Common Side Effects
- Swelling in the arms or legs
- Neck pain
- Having trouble falling or staying asleep
- Tingling or burning sensation
- Muscle spasms
- Weakness
- Injection site reactions (e.g., pain, redness)
Evenity (romosozumab) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Heart attack: chest pain, pain in the middle or upper back, jaw and throat discomfort, shortness of breath, feeling dizzy
- Stroke: headache, vision changes, loss of balance, trouble talking, weakness or numbness on only one side of the body, droopy face, trouble breathing, nausea, confusion
- Fracture in the thigh: dull or aching pain in the thigh, hip, or groin
- Allergic reaction: hives; rash; swelling of the face, lips, mouth, or tongue; trouble breathing or swallowing
The following Evenity (romosozumab) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions or angioedema—skin rash, itching or hives, swelling of the face, eyes, lips, tongue, arms, or legs, trouble swallowing or breathing
- Heart attack—pain or tightness in the chest, shoulders, arms, or jaw, nausea, shortness of breath, cold or clammy skin, feeling faint or lightheaded
- Low calcium level—muscle pain or cramps, confusion, tingling, or numbness in the hands or feet
- Osteonecrosis of the jaw—pain, swelling, or redness in the mouth, numbness of the jaw, poor healing after dental work, unusual discharge from the mouth, visible bones in the mouth
- Severe bone, joint, or muscle pain
- Stroke—sudden numbness or weakness of the face, arm, or leg, trouble speaking, confusion, trouble walking, loss of balance or coordination, dizziness, severe headache, change in vision
Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):
- Headache
- Joint pain
- Muscle spasms
- Pain, redness, or irritation at injection site
- Swelling of the ankles, hands, or feet
Pros and cons of Evenity (romosozumab)
Pros
- Helps with bone growth and prevents bone loss at the same time
- Given just once a month
- Only need 1 year of treatment
Cons
- Needs to be injected
- Must go to the medical office for each injection
- Bone mineral density eventually goes back to where it was before after stopping the medication
Pharmacist tips for Evenity (romosozumab)
- You get your Evenity (romosozumab) injections once a month. Put your appointments for the injections in your calendar to help remember when they are. Getting your medication on time can help it work as best as it can to make your bones stronger.
- If you miss your appointment for your Evenity (romosozumab) injections, call to reschedule it as soon as you can. Your next appointment will be one month from that rescheduled date.
- At each appointment, you'll be given two injections of Evenity (romosozumab). They're given one after the other in two different spots. It's injected under the skin of your stomach, thigh, or the back of the upper arm.
- It’s common to feel pain or have swelling where you got the Evenity (romosozumab) injections. This can happen a few hours after the injections, but then go away in a day or so. You can wrap an ice pack in a towel and place it on your skin to help feel better. But tell your care team if these reactions don’t go away or bother you a lot.
- You should take calcium and vitamin D supplements while you’re taking Evenity (romosozumab). These supplements help keep your bones strong.
- Practice good oral hygiene to help lower the risk of jawbone problems from Evenity (romosozumab). Brushing your teeth and flossing each day can help with this. Also, tell your prescriber if you’re having dental surgery. And, let your dentist know you’re taking Evenity (romosozumab).
Common questions about Evenity (romosozumab)
Once you're taking Evenity (romosozumab) regularly, the medication can stay in your system for about 2 months after each dose. This is estimated from the medication's half-life. The half-life measures how long it takes for half of the medication to leave your body. Even though the medication stays in your system for a while, it's still important to go to your appointment every month. This is because the effects of the medication can start to go away if you wait too long between doses.
When you take Evenity (romosozumab), it can take months for your bone strength to improve. Your bone strength is measured by your bone mineral density (BMD). Since the medication works over several months, you might not feel it actually working. But it’s important to keep going to your monthly injection appointments. This helps Evenity (romosozumab) work its best to make your bones stronger. Your prescriber might have you get a bone density scan (DEXA scan) to check your BMD. Talk to your prescriber if you have other questions about how long the medication is taking to work for you.
A healthcare professional at the medical office will give you two injections of Evenity (romosozumab) each time. The injections are given under the skin, one right after the other, in two different spots. It's injected into either your stomach, thigh, or the back of your upper arm. Tell the healthcare professional if any areas are tender, bruised, red, hard, scarred, or has stretch marks. They'll try to avoid injecting into these areas. You'll get these injections once a month for up to 12 months. Talk to your prescriber if you have questions about what to expect with Evenity (romosozumab).
Hair loss or alopecia isn't a usual side effect of Evenity (romosozumab). Remember, hormone changes after menopause and growing older can also be a cause of hair loss. If your hair starts thinning or falling out while taking this medication, let your care team know. They can find ways to help with this side effect.
No, Evenity (romosozumab) isn't a bisphosphonate. It's another type of osteoporosis medication called a sclerostin inhibitor. What makes Evenity (romosozumab) different is that it works in two ways. It helps with bone growth and prevents bone loss at the same time. In comparison, bisphosphonates like alendronate (Fosamax) only work in one way. They only prevent bone loss. Talk to your prescriber about the different types of osteoporosis medications. They can help you decide which is right for you.
After you stop taking Evenity (romosozumab), your bone mineral density (BMD) can go back to what it was before you started the medication. This can happen within a year of stopping it. That's why your prescriber will talk to you about switching to a different osteoporosis medication after you finish taking Evenity (romosozumab). This helps keep the bone you built. Examples of these medications include alendronate (Fosamax) or Prolia (denosumab). They help stop bone loss. Talk to your prescriber about which medication is best for you after you stop taking Evenity (romosozumab).
A study showed that people who took Evenity (romosozumab) for a year had about a 70% lower risk of spine fractures than those who took a placebo. The medication hasn’t been shown to lower the risk of fracture in other parts of the body. But after a year, Evenity (romosozumab) made bones stronger overall. It improved bone strength (bone mineral density or BMD) in the thigh and hip bone by a little over 5% compared to placebo. It also improved BMD in the spine by around 13% compared to placebo. Your prescriber might have you get a bone density scan (DEXA scan) to see how well the medication is working. Talk to your prescriber about how well Evenity (romosozumab) might work for you.
Evenity (romosozumab) and Prolia (denosumab) are two different types of osteoporosis medications. Evenity works in two ways — it helps with bone growth and prevents bone loss at the same time. But Prolia just works to prevent bone loss. Both are injections given under the skin, but how often they're given is different. Evenity is given once a month, but it's less often for Prolia (once every 6 months). Another difference is that there's no set limit to how long you can take Prolia. But you can only take Evenity for up to 12 months before needing to switch to a different medication. Talk to your prescriber to compare Evenity and Prolia to see which is right for you.
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Risks and warnings for Evenity (romosozumab)
Evenity (romosozumab) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Risk of heart attack, stroke, or heart-related death
- Risk factors: Heart attack or stroke in the last year | High blood pressure | High cholesterol | Diabetes | Larger body size | Smoking
In studies, more heart attacks, strokes, and heart-related deaths happened in people taking Evenity (romosozumab) than in those taking alendronate (Fosamax). Because of this risk, you shouldn't take Evenity (romosozumab) if you've had a heart attack or stroke within the past year.
Before you start Evenity (romosozumab), tell your prescriber your full medical history. This is extra important if you've had a heart attack or stroke before. They can check if you have other risk factors. This includes high blood pressure, high cholesterol, diabetes, and smoking. Your prescriber can help you decide if Evenity (romosozumab) is safe and the right choice for you.
While taking Evenity (romosozumab), watch for signs of a heart attack like chest pain, back pain, trouble breathing, and dizziness. Also look out for signs of a stroke. This includes headache, vision changes, trouble talking, nausea, and weakness on one side of your body or face. Call 911 right away if this happens.
Low calcium levels (hypocalcemia)
- Risk factors: History of severe kidney problems | Receiving dialysis
Some people can have low calcium levels while taking Evenity (romosozumab). You'll need to get any low calcium treated first before starting this medication.
Tell your prescriber if you have severe kidney damage or are on dialysis. You're at risk of having low calcium levels. If you're at risk, you'll need regular blood tests during treatment so your prescriber can check your calcium levels. You'll also need to take calcium and vitamin D supplements while taking Evenity (romosozumab).
Let your care team know if you have symptoms of low calcium. They can include muscle spasms, brittle nails, and dry skin. You might also have numbness in the fingers, toes, or around your mouth.
Risk of problems in the jawbone (osteonecrosis of the jaw)
- Risk factors: Poor oral hygiene | Current infection in the mouth | Dental issues | Anemia | Bleeding condition | Cancer | Radiation treatment | Taking other medications linked to jawbone problems (e.g., steroids, chemotherapy, bisphosphonates)
Some people taking Evenity (romosozumab) have had osteonecrosis of the jaw (ONJ). This happens when the jawbone breaks down.
Talk to your prescriber about your risk of ONJ. The chance is higher if you have an infection in the mouth or jaw. It's also higher if you have dental issues or poor oral hygiene. Taking steroids or osteoporosis medications like alendronate (Fosamax) can raise your risk too. Your prescriber might want you to get a dental exam before starting Evenity (romosozumab).
It's important to have good oral hygiene while taking Evenity (romosozumab). Brush and floss your teeth every day, and get dental cleanings when recommended. Tell your prescriber if you need a dental procedure while taking this medication. Also, let your dentist or oral surgeon know you're taking Evenity (romosozumab). They can talk to you about the risks and benefits of getting dental work done.
Watch for symptoms of ONJ. This includes pain, swelling, exposed bone in the affected area. There also might be drainage from the mouth. Call your prescriber or dentist right away if this happens.
Risk of fractures in the thigh
Some people taking Evenity (romosozumab) have had fractures in the thigh. It can happen anywhere along your thigh bone. Usually, these fractures happen even with little or no trauma to the thigh.
You might feel a dull or aching pain in the thigh area weeks to months before a fracture happens. It’s important to look for these signs while taking Evenity (romosozumab). Tell your care team about any new or unusual hip, thigh, or groin pain. They can examine you and check if there's a fracture.
Evenity (romosozumab) dosage
Typical dosage for Evenity (romosozumab)
Evenity (romosozumab) is an injection that's given by a healthcare professional.
The typical dose is two injections (210 mg total) under the skin once a month for 12 months.
Evenity (romosozumab) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Evenity (romosozumab) will not be safe for you to take.
- Low calcium levels (hypocalcemia)
What are alternatives to Evenity (romosozumab)?
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