Short answer: Evenity (romosozumab-aqqg) is 210 mg given as two injections once a month for 12 doses by a healthcare provider; Reclast (zoledronic acid) is a 5 mg infusion, once a year for most uses.12 Evenity carries a boxed warning on heart attack, stroke and cardiovascular death; Reclast has none. Evenity's label compared it with alendronate, not Reclast.
| Evenity | Reclast | |
|---|---|---|
| Drug type | Sclerostin inhibitor1 | Bisphosphonate2 |
| Approved for | Postmenopausal women with osteoporosis at high fracture risk1 | Treat and prevent postmenopausal osteoporosis; men; steroid-induced osteoporosis; Paget's disease2 |
| How given | Two 105 mg injections under the skin, one after the other, by a healthcare provider1 | 5 mg into a vein over at least 15 minutes2 |
| How often and how long | Once a month for 12 doses; then an anti-resorptive medicine may be considered1 | Once a year; stopping may be considered after 3 to 5 years at low risk2 |
| Kidney | Severe impairment or dialysis: higher risk of low calcium, which is monitored1 | Not used with creatinine clearance under 35 mL/min2 |
| Side effects in label trials | Joint pain 13.1% vs 12.1% on placebo; headache 6.6% vs 5.8%1 | Fever 17.9% vs 4.6% on placebo; muscle pain 11.7% vs 3.7%2 |
| Missed dose | Given as soon as it can be rescheduled, then monthly from that date1 | Call your provider to schedule the next dose2 |
| Boxed warning | WARNING: POTENTIAL RISK OF MYOCARDIAL INFARCTION, STROKE AND CARDIOVASCULAR DEATH1 | None2 |
In a 12-month trial against alendronate, major heart events (cardiovascular death, heart attack or stroke) were 2.0% on Evenity vs 1.1%. Against placebo they were 0.8% in both groups. Evenity is not started within a year of a heart attack or stroke and is stopped if one happens during treatment.1 Reclast's label lists atrial fibrillation: serious events were 1.3% vs 0.4% on placebo in its 3-year trial, mostly more than a month after the infusion.2 These numbers come from separate trials with different people, lengths and methods, so they are not a head-to-head comparison.
Both labels list low blood calcium, jaw bone death and unusual thigh fractures, and both call for calcium and vitamin D.12 Reclast adds acute kidney failure and a flu-like reaction in the first 3 days after the infusion.2 After 12 Evenity doses, the label says an anti-resorptive medicine may be considered, without naming one.1
Which, if either, fits is for your prescriber. More detail: Evenity side effects, Reclast side effects, the Evenity and Reclast dosing schedules, the Evenity and Reclast missed-dose pages, the romosozumab and zoledronic acid guides, and Prolia vs Evenity: how do the two osteoporosis injections differ?.