Evenity vs. Forteo
See how Evenity and Forteo compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Evenity is a once-monthly injection capped at 12 lifetime doses, while Forteo is injected daily and is typically used for up to two years.
Evenity carries a boxed warning for cardiovascular events, while Forteo's earlier osteosarcoma warning was removed from its FDA label in 2021.
Forteo covers a broader group of patients, including men and people with glucocorticoid-induced osteoporosis, while Evenity is approved only for postmenopausal women.
Evenity vs. Forteo Drug Summary
Evenity
Evenity is a sclerostin inhibitor, a bone-forming injectable antibody used to treat osteoporosis in postmenopausal women at high risk for fracture. It's given as one monthly subcutaneous injection of two syringes, for a maximum of 12 doses total.
Forteo
Forteo is a parathyroid hormone analog that builds new bone in people with several types of osteoporosis, including postmenopausal, male, and glucocorticoid-induced disease. It's self-injected once a day using a prefilled pen, typically for up to two years.
Evenity vs. Forteo Side Effects
Evenity
Forteo
Evenity vs. Forteo Dosage
Evenity
Forteo
| STAGE | DOSE | WHEN |
| Starting dose | 210 mg once monthly | At the start |
| Maximum dose | 210 mg once monthly | Same as starting |
| Dose changes | None | Fixed dose |
| STAGE | DOSE | WHEN |
| Starting dose | 20 mcg once daily | At the start |
| Maximum dose | 20 mcg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Evenity
| STAGE | DOSE | WHEN |
| Starting dose | 210 mg once monthly | At the start |
| Maximum dose | 210 mg once monthly | Same as starting |
| Dose changes | None | Fixed dose |
Forteo
| STAGE | DOSE | WHEN |
| Starting dose | 20 mcg once daily | At the start |
| Maximum dose | 20 mcg once daily | Same as starting |
| Dose changes | None | Fixed dose |
Evenity vs. Forteo Indications
Evenity
Evenity is FDA-approved specifically for postmenopausal women who are at high risk of fracture. It is not approved for men or for premenopausal women of any age.
Postmenopausal osteoporosis with high fracture risk
Not approved for men
Not approved for premenopausal women
Requires antiresorptive follow-up therapy after treatment
Forteo
Forteo is FDA-approved for a broader group, including postmenopausal women, men with primary or hypogonadal osteoporosis, and adults with glucocorticoid-induced osteoporosis. It is not approved for pediatric patients with open growth plates.
Postmenopausal osteoporosis with high fracture risk
Men with primary or hypogonadal osteoporosis
Glucocorticoid-induced osteoporosis in men and women
Not approved for pediatric patients with open epiphyses
Evenity vs. Forteo Pros and Cons
Evenity
Evenity works by both increasing bone formation and decreasing bone breakdown, a mechanism unique among osteoporosis drugs. Its boxed warning for cardiovascular events and one-time 12-dose limit shape who is a good candidate.
Pros
Only osteoporosis drug that builds bone and blocks resorption at once
Just one injection appointment per month instead of daily
Roughly $1,825 to $2,629 per month before insurance, less than Forteo's list price
Cons
Boxed warning for heart attack, stroke, and cardiovascular death
Cannot be started within a year of a heart attack or stroke
Limited to a maximum of 12 doses over a lifetime
Only approved for postmenopausal women, not men
Forteo
Forteo has decades of use as a bone-building therapy and covers a wider range of osteoporosis types, including in men and steroid-induced bone loss. Daily injections and a higher price are the main trade-offs for many patients.
Pros
Approved for men and for glucocorticoid-induced osteoporosis, not just postmenopausal women
No boxed warning on the current label; the osteosarcoma warning was removed in 2021
Longer real-world track record, on the market since 2002
Cons
Requires a self-injection every single day
Roughly $4,590 to $5,100 per month before insurance, more than Evenity's list price
Should be avoided in people with elevated baseline risk of osteosarcoma
Early doses can cause a brief drop in blood pressure when standing
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