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

Most common
arthralgia (up to 13.1%)
headache (≥5%)
injection site reactions (up to 4.9%)
nasopharyngitis (≥2%)

Forteo

Most common
pain (up to 21.3%)
arthralgia (up to 10.1%)
asthenia (up to 8.7%)
nausea (up to 8.5%)

Evenity vs. Forteo Dosage

Evenity

Dosage
Dosage Table
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

Dosage
Dosage Table
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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