Evenity vs. Reclast
See how Evenity and Reclast compare on approved uses, dosing, side effects, and cost.
Key Takeaways
Evenity builds new bone and slows bone loss at the same time, while Reclast (zoledronic acid) is a bisphosphonate that only slows bone breakdown.
Evenity is a monthly injection capped at 12 doses for life, while Reclast is an IV infusion given just once a year or once every two years.
Evenity carries a boxed warning for heart attack, stroke, and cardiovascular death, while Reclast's main risks are kidney problems, flu-like reactions, and jaw bone loss.
Evenity vs. Reclast Drug Summary
Evenity
Evenity (romosozumab-aqqg) is a sclerostin inhibitor, a type of monoclonal antibody that both builds new bone and slows bone breakdown. It is given as a once-monthly subcutaneous injection using two syringes and is FDA-approved for postmenopausal women at high risk for fracture. Treatment is capped at 12 monthly doses in a lifetime.
Reclast
Reclast (zoledronic acid) is a nitrogen-containing bisphosphonate that slows the natural breakdown of bone. It is given as an intravenous infusion by a healthcare provider, typically once a year for treatment or once every two years for prevention. It is FDA-approved for postmenopausal osteoporosis, men with osteoporosis, glucocorticoid-induced osteoporosis, and Paget's disease of bone.
Evenity vs. Reclast Side Effects
Evenity
Reclast
Evenity vs. Reclast Dosage
Evenity
Reclast
| 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 | 5 mg IV infusion | At the start |
| Maximum dose | 5 mg IV infusion | 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 |
Reclast
| STAGE | DOSE | WHEN |
| Starting dose | 5 mg IV infusion | At the start |
| Maximum dose | 5 mg IV infusion | Same as starting |
| Dose changes | None | Fixed dose |
Evenity vs. Reclast Indications
Evenity
Evenity is FDA-approved only for osteoporosis in postmenopausal women who are at high risk for fracture, such as those with a prior fracture or multiple risk factors. It is not approved for men, premenopausal women, or women who may become pregnant.
Postmenopausal women at high risk for fracture
History of an osteoporotic fracture
Multiple risk factors for fracture
Not approved for men or premenopausal women
Reclast
Reclast covers a wider range of uses than Evenity, including treatment and prevention of osteoporosis in postmenopausal women, increasing bone mass in men, and treating glucocorticoid-induced osteoporosis. It is also FDA-approved for Paget's disease of bone in men and women.
Treatment and prevention of postmenopausal osteoporosis
Men with osteoporosis (to increase bone mass)
Treatment and prevention of glucocorticoid-induced osteoporosis
Paget's disease of bone
Evenity vs. Reclast Pros and Cons
Evenity
Evenity's ability to both build new bone and reduce bone breakdown sets it apart from bisphosphonates, but that comes with a boxed cardiovascular warning and a hard lifetime dose limit. Monthly clinic visits and a higher monthly price add to the treatment burden.
Pros
Only therapy that builds new bone and reduces bone breakdown at the same time
One monthly visit instead of daily injections used with some other bone-building drugs
Studied specifically in postmenopausal women at high fracture risk
Cons
Boxed warning for heart attack, stroke, and cardiovascular death
Cannot be started within a year of a heart attack or stroke
Capped at 12 doses in a lifetime, then a different drug is needed to keep the gains
Not approved for men or premenopausal women
Reclast
Reclast has decades of use and a broader label than Evenity, but it only slows bone loss rather than building new bone. Its once-yearly infusion means far fewer doses per year, though each one commonly triggers a short flu-like reaction.
Pros
Given as an infusion just once a year, or once every two years for prevention
Approved for a wider range of patients, including men, glucocorticoid-induced osteoporosis, and Paget's disease
No boxed cardiovascular warning
Cons
Common flu-like reaction (fever, muscle aches) after infusion, especially the first one
Cannot be used with significant kidney impairment (creatinine clearance under 35 mL/min)
Only slows bone breakdown; does not stimulate new bone formation like Evenity
Requires an in-office IV infusion of at least 15 minutes plus pre-infusion hydration and kidney checks
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